The hiatus hernia is the clinical manifestation of the upper part of the stomach sliding into the chest cavity through the weakened diaphragmatic hiatus or a weakened lower esophageal sphincter. Many undiagnosed sufferers of hiatal hernia have symptoms of the gastro esophageal reflux disease.
There are two major types of hiatus hernia: the sliding hernia occurs when both the gastroesophageal junction and the upper part of the stomach slide back into the chest cavity. They can remain permanently inside the chest or only slide upwards during the swallowing process, when the esophagus contracts and shortens due to contraction pulling on the stomach. When the swallowing is completed, the junction falls back in the abdomen.
The second type of hiatus hernia is the Para esophageal one when the junction remains at its place but the upper part of the stomach is squeezed beside the esophagus and up into the chest. The most common complications of this type of hernia are incarceration and strangulation.
The occurrence of hiatus hernia can be caused by several factors like weightlifting, abdominal injuries with lesions of the diaphragmatic hiatus, high pressure inside the abdominal cavity due to coughing, vomiting or bowel movements, pregnancy, obesity, tight clothes or constipation.
Most of the sufferers from hiatus hernia have no symptom manifestations; some of them still, can experience heartburn, regurgitation, vomiting, and gastroesophageal reflux disease, sour or bitter taste inside the mouth, often belching or hiccups, chest pain radiation. Other possible symptoms in case of hiatus hernia are increased chest pressure, bloating after meals, abdominal pressure and discomfort, discomfort and pain in the esophageal or stomach area, difficulties during swallowing, gas and unexplained dry cough.
The most frequently associated conditions with the hiatus hernia are the erosive esophagiis due to the acid contents of the stomach refluxed into the esophagus and the Though Barrett’s esophagus also connected to the gastroesophageal reflux disease.
The most used technique to diagnose a hiatal hernia is the Barium X-ray when the patient swallows liquid containing barium which covers the esophageal and stomach walls making them visible for the X-rays. Another technique is the upper endoscopy allowing the doctor to visualize esophagus, stomach and duodenum; it is performed with a thin and flexible lighted tube. Another testing for detecting the existence of heartburn symptoms is the Bernstein Test. Also called acid perfusion test, it is used in combination with other functional techniques like the barium X-ray to determine the existence of gastroesophageal reflux caused by a hiatus hernia.
Patients with no clinical manifestation require no treatment. The ones with medium changes need lifestyle changes and medication to control the condition and only the ones with severe symptoms and eventual complications require surgical intervention.
By: Groshan Fabiola