hiatal hernia (also called hiatus or diaphragmatic hernia), a cost in India

Know More About Procedure & Surgery

What is hiatal Hernia?

A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region. The diaphragm is a large muscle that lies between your abdomen and chest. We use this muscle to help us breathe. Normally, your stomach is below the diaphragm, but in people with a hiatal hernia, a portion of the stomach pushes up through the muscle. The opening it moves through is called a hiatus. This condition mostly occurs in people who are over 50 years old. It affects up to 60 percent of people by the time they’re 60 years old, according to the Esophageal Cancer Awareness Association.

Causes

In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm. Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:

• coughing
• vomiting
• straining during bowel movements
• lifting heavy objects

Some people are also born with an abnormally large hiatus. This makes it easier for the stomach to move through it. Factors that can increase your risk of a hiatal hernia include:

• obesity
  
• aging
• smoking
  

Types of Hiatal Hernia

Two types of hiatal hernia:

• Sliding hiatal hernias
• Fixed, or paraesophageal, hernias.

Sliding hiatal hernia - This is the more common type of hiatal hernia. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus. Sliding hernias tend to be small. They usually don’t cause any symptoms. They may not require treatment.

Fixed hiatal hernia - This type of hernia isn’t as common. It’s also known as a paraesophageal hernia.In a fixed hernia, part of your stomach pushes through your diaphragm and stays there. Most cases are not serious. However, there is a risk that blood flow to your stomach could become blocked. If that happens, it could cause serious damage and is considered a medical emergency.

Symptoms of a hiatal hernia

Common symptoms include:

• heartburn that gets worse when you lean over or lie down
• chest pain or epigastric pain
  
• trouble swallowing
  
• belching
  
• Bad taste in your mouth
• Upset stomach and vomiting
• Backflow of food or liquid from your stomach into your mouth
• Shortness of breath

Diagnosis

Barium X-ray

Your doctor may have you drink a liquid with barium in it before taking an X-ray. This X-ray provides a clear silhouette of your upper digestive tract. The image allows your doctor to see the location of your stomach. If it’s protruding through your diaphragm, you have a hiatal hernia.

Endoscopy

Your doctor may perform an endoscopy. He or she will slide a thin tube in your throat and pass it down to your esophagus and stomach. Your doctor will then be able to see if your stomach is pushing through your diaphragm. Any strangulation or obstruction will also be visible.

Treatment

If you have acid reflux and heartburn, you may be treated with medications or, if those don’t work, surgery.

Medications your doctor may prescribe include:

• over the counter antacids to neutralize stomach acid
• over the counter or prescription H2 receptor blockers that lower acid production
• over the counter or prescription proton pump inhibitors to prevent acid production, giving your esophagus time to heal

Surgery

If medications don’t work, you might need surgery on your hiatal hernia. However, surgery is not commonly recommended. Surgery is generally used for people who aren't helped by medications to relieve heartburn and acid reflux, or have complications such as severe inflammation or narrowing of the esophagus. Surgery to repair a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing an esophageal sphincter or removing the hernia sac. Or your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery). Sometimes surgery is done using a single incision in your chest wall (thoracotomy).

Hernias can come back after surgery. You can reduce this risk by:

• staying at a healthy weight
• getting help lifting heavy objects
• avoiding strain on your abdominal muscles

Lifestyle changes

Acid reflux causes most hiatal hernia symptoms. Changing your diet can reduce your symptoms. It may help to eat smaller meals several times a day instead of three large meals. You should also avoid eating meals or snacks within a few hours of going to bed.

There are also certain foods that may increase your risk of heartburn. Consider avoiding:

• spicy foods
• chocolate
• foods made with tomatoes
• caffeine
• onions
• citrus fruits
• alcohol

Other ways to reduce your symptoms include:

• stopping smoking
• raising the head of your bed by at least 6 inches
• avoiding bending over or lying down after eating

Reducing your risk of hiatal hernias

You may not avoid a hiatal hernia entirely, but you can avoid making a hernia worse by:

• losing excess weight
  
• not straining during bowel movements
• getting help when lifting heavy objects
• avoiding tight belts and certain abdominal exercises