Although hiatus hernia is quite rare, some individuals have a higher predisposition to it. To understand what this pathological condition is all about, imagine that part of your stomach is squeezing through a space in your diaphragm (a respiratory muscle) into your chest cavity. As you probably know, the diaphragm is a unique muscle whose primary function is to facilitate breathing in humans. This muscle partitions the thoracic cavity from the abdominal cavity, and when you inhale, it enlarges the thoracic cavity, allowing your lungs to fill with air. In a healthy patient, this is what happens; however, with a hiatal hernia, this muscle does not function correctly.
The muscle fails to close, resulting in a portion of the stomach moving up into the chest cavity. This can be classified into various forms. There can also be a wide range of stressors. Patients with it may experience great distress due to hiatal hernia. Therefore, it is crucial to treat this specific condition. An early diagnosis and correct treatment prevent complications. Find out more about hiatal hernia here.
There is not just one type of hiatal hernia, but three. This is an important distinction, as hernias can be in different places. Also the diaphragm and/or stomach can be displaced in different ways. Hiatal hernia is classified into these types: sliding, rolling, and also mixed. These also have different severities and clinical manifestations.
Most patients undergoing treatment for hiatal hernia have this most prevalent form of hiatal hernia in the general population. The sliding type comprises up to 90% of all cases. In this condition, part of the stomach spills into the chest through a hole in the diaphragm. This hernia is small, so it typically doesn't cause symptoms, although some patients do have some issues. A sliding hiatal hernia can also go in and out, resulting in symptoms that may go away and come back.
This type is also known as a paraesophageal hiatal hernia. In contrast to other forms of hiatal hernia, here a portion of the stomach sits adjacent to the esophagus, not above it. This is because a portion of the stomach that participates in the pathological process rotates, crosses through the hiatus, and fixes laterally as a hernia. This type of hiatal hernia is less common and can also be without symptoms. But if not treated, it may turn into bleeding and other issues.
However, the hernia may have features of both the above types. This mixed form has an element of the stomach pushed via the oesophageal opening into the chest, similar to the sliding type. At the same time, part of the stomach or other structures around the chest side next to the oesophagus can be seen, resembling a paraesophageal hernia's qualities.
The causes of hiatal hernia can vary, as several factors can lead to this condition. These consist of anatomical aspects and also the way of living. It is vital to know the reason behind hiatal hernia for effective treatment. Learn about the most prevalent reasons for this type of hernia.
The muscles of the diaphragm can weaken. Ageing naturally causes the diaphragm muscles surrounding the oesophagus and stomach to weaken. So, this condition is more common in seniors. However, the diaphragm muscles can also be weakened by neurological diseases. Diseases of this type can damage the nerves controlling this muscle.
In addition, muscle and bone weakness, specifically weakness of the diaphragm muscle, can cause a hernia due to insufficient or complete lack of physical activity. Sometimes, weakness comes from chest or abdominal injury or surgery. In addition, lung problems, such as lung disease or smoking, which reduce lung function, can make muscles weak.
Another critical factor that leads to hiatal hernia is high intraabdominal pressure. For multiple reasons, there is a rise in unnecessary pressure exerted on the stomach and the oesophagus. In turn, stretching out the muscle to let bits of your stomach fall through a hole into your chest. Likewise, causes of hiatal include obesity, pregnancy, or heavy lifting, all of which increase pressure in the abdomen. Health issues like chronic cough or constipation can also exacerbate this pressure.
Another cause of hiatal hernia is congenital. It could just be that some people are wired to be made with a fragile diaphragm. This may be a developmental weakness or relaxation of the diaphragmatic muscles at the level of the oesophageal hiatus. Potential causes also include congenital disabilities and functional malformations. Anatomical disorders exist too that elevate the pressure within the abdominal cavity. Diagnosing a hiatal hernia as congenital requires excluding other causes and analyzing the anatomical image.
Hiatal hernias are often but not always asymptomatic, so it is not uncommon for individuals to be unaware they have this issue. However, it is important to know about it, since a hernia can have troublesome consequences. Note that this condition can be detected in your imaging test. Nevertheless, in most cases, the disease is expressed by many symptoms. They can heavily impact the lives of people on a day-to-day basis.
We know that the mechanism of action for hiatal hernia is the relaxation of the lower oesophageal sphincter muscle. If your muscles are working properly, then food can travel into your stomach from your oesophagus, but it cannot flow back up. In the case of a hiatal hernia, however, it does not work. The abnormal process results in gastric content reflux into the oesophagus and irritation of the mucosa. Which is why it tends to feel like a fire in the chest, aka heartburn.
Another sign is excessive belching. Individuals with this issue often feel that upon finishing a meal, air or some stomach material regurgitates into the esophagus. This symptom is mild but can be an annoyance. During the night, belching can be troublesome, disrupting sleep and producing discomfort.
Vomiting is another symptom that happens due to irritation and inflammation of the mucosa lining of the oesophagus. Nausea and vomiting could also be because of malignant acid reflux, as the belly attempts to eliminate unpleasant content, which unfortunately aggravates the symptoms.
Difficulty swallowing is another sign to look out for. To better understand what exactly difficulty swallowing means, imagine the feeling you get when you try to swallow food and feel like it is stuck in your throat. Sufferers find the act of swallowing difficult, often causing them to steer clear of bigger meals. This sensation is not only uncomfortable, though, if the issue persists long enough, the result can be malnutrition!
Moreover, sometimes a pain appears in the upper abdomen and under the heart, which is often mistaken for a heart attack. The pain can be burning and pressing, and it can get worse after meals or when you lie down, triggering a great deal of anxiety that often requires a doctor's visit.
A further alarming sign is hoarseness in the morning due to the stomach contents coming to the oesophagus during the night and irritating the vocal cords.
Reflux may also cause dry coughing and wheezing. The cough is nonproductive and frequent at night or in the morning, and constant coughing may lead to wheezing as stomach acid irritates the airways.
The diagnosis of hiatal hernia usually begins with a detailed medical history, during which the doctor asks about symptoms characteristic of this condition. Imaging tests are very important because doctors use them to confirm a hernia.. Learn about diagnostic methods.
Imaging of the upper gastrointestinal tract is essential in hiatal hernia. The doctor inserts a special device through the mouth into the oesophagus and stomach during endoscopy. This test can be an uneasy feeling for patients. It may cause discomfort, gagging, and anxiety. Nevertheless, this test is significant because it allows for an accurate assessment of the condition of the oesophagus and stomach. In the case of hiatal hernia, endoscopy also allows for detecting possible complications, such as inflammation or ulcers.
This is another important test to confirm a hiatal hernia. This involves the patient swallowing a tablet containing a special barium solution. While the patient is swallowing, the doctor takes X-ray images. This test is well tolerated for many patients, although it may cause discomfort in some, especially if they are prone to nausea or sensitive to contrast. However, it allows doctors to accurately assess the shape and function of the oesophagus and detect any hernias, reflux, or narrowing.
In some cases, additional tests, such as an oesophageal pH test, are necessary. This specific medical procedure records the acidity level in the lower part of the oesophagus. An oesophageal pH test can also be uncomfortable for patients, as it requires a probe to be put through the nose into the oesophagus. However, in some cases, a pH test is very helpful. It is considered for patients with GERD. This allows for a better understanding of whether the patient's symptoms are related to excessive acid reflux and whether drug treatment or other therapeutic interventions are necessary.
Pressure testing can also be helpful. It involves checking the strength of the muscles in the oesophagus. This test is not painful, but it can be unpleasant or uncomfortable because sometimes a thin tube needs to be inserted into the body. However, patients do not usually experience much discomfort during manometry.
Different methods are make to treat hiatal hernia based on the degree of disease, symptoms, and other factors. Medications and pills are good for mild hiatal hernia with mild symptoms. When pharmacological treatment does not resolve the symptoms, surgery is the chosen approach. Other factors, such as age, other medical conditions, and patient preference, also form part of the treatment choice. Beyond pharmacological and surgical therapy, lifestyle modifications are key, too.
Pharmacotherapy in the treatment of hiatal hernia means taking pills that lessen the intensity of discomforting symptoms. Usually, the doctor prescribes medicines to reduce stomach acid secretion, or medicines to protect the stomach lining. Thanks to them, symptoms can be relieved, and the condition of the oesophagus will improve. Pharmacotherapy also prevents other complications of hiatal hernia.
Laparoscopic surgery is a special method. It is a less invasive surgical approach utilized to address hiatal hernias. Generally, this involves creating a few tiny cuts in the wall of your belly and inserting a device with a small camera in it. During this procedure, the surgeon gets rid of the hernia. Then, they put the stomach back where it belongs. This surgery can also strengthen the lower oesophageal sphincter. Finally, the surgical wounds are stitched up.
In more complex scenarios, open surgery may be needed. The surgeon makes an incision in the chest or abdomen to get to the stomach and diaphragm. Because of this, this process may be much more painful for the patient and may take longer to heal. However, sometimes laparoscopy cannot be performed safely. In such situations, open operation remains the only option. Such cases include patients with extensive scars and/or adhesions from prior surgeries or large or complicated hiatal hernias. Also, when complications arise, such as internal bleeding, then more direct and complete access to the surgical area is needed.
Lifestyle changes are good for all types of hernias. Changes include diet. Experts advise against high consumption of fat. It is also essential to keep the body weight stable to relieve pressure on the stomach and increase the patient's comfort. Stopping smoking is another aspect of the management of hiatal hernia, since nicotine and cigarette smoke aggravate the disease. Therefore, giving up smoking will help improve the digestive function and decrease the symptoms.
In addition, one of the crucial things is to be in the right position when lying down. Good posture may alleviate some symptoms. One such tip is to sleep with your head a few centimetres higher, ideally on a pillow, to avoid any reflux of the stomach acid back up. When symptoms are intermittent in nature, dietary and lifestyle changes may be the only treatment option needed, with no drugs or surgery necessary.
A hiatal hernia is where some of the stomach shifts a little higher up into the chest instead of staying where it should be. There are two main types of conditions, although a mixed one is also possible. However, the reasons behind it can differ, for instance, ageing, overweight, chronic cough, or lifting weights. So are some congenital causes. While a hiatal hernia will often not produce any symptoms, it may also cause heartburn, aching in the chest, or difficulty swallowing. There are different ways in which hernia doctors identify hiatal hernia. There are also effective methods of treatment.
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