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What is Hiatus Hernia

Hiatus means opening. A diaphragm is a muscle wall that separates the chest cavity and the abdomen cavity. The esophagus or the food pipe passes through an opening (hiatus) in the diaphragm to the abdomen cavity. This hiatus is guarded by a called crura of the diaphragm. These crura of the diaphragm prevent the stomach from sliding into the chest cavity. When the crura of the diaphragm become loose or when the opening becomes bigger, a part of the stomach pushes through the hiatus and enters the chest cavity. This condition is termed as a hiatal hernia.

Types of Hiatus Hernia

There are two types of a hiatus hernia. They are Sliding Hiatus Hernia and Paraesophageal Hiatus Hernia.

In a Sliding Hiatus Hernia, part of the esophagus and part of the stomach that joins the esophagus pushes up into the chest cavity.
In Paraesophageal Hiatus Hernia, the esophagus and the stomach part that joins the esophagus remain in their original position but a part of the upper stomach (fundus) pushes up into the upper cavity.
Sliding Hiatus Hernia is more common than Paraesophageal Hiatus Hernia

General Symptoms of Hiatus Hernia

Generally speaking, hiatus hernia is asymptomatic or does not cause any symptoms. This is one of the main causes of GERD
Some people with a hiatus hernia may show heartburn or acid reflux, a symptom common with GERD.
A sour taste in the mouth in the early morning.
Sometimes vomiting, burping, belching and feeling nausea
Difficulty while swallowing food

Causes of Hiatus Hernia

The exact cause for a hiatus hernia to occur is not known. However, the following reasons are generally suspected.

Some people may be born with bigger hiatus.
Weak muscles in the diaphragm

Factors that can aggravate Hiatus Hernia

Obesity
Aging
Smoking
Lifting heavy object in household chores or while working out.
Straining while passing stools. Generally, constipated individuals aggravate their hiatus hernia

Diagnosis of Hiatus Hernia

Abdominal X-rays or abdominal ultrasound can diagnose the presence of hiatus hernia
The gold standard diagnosis method is the upper GI endoscopy.

Complications of Hiatus Hernia

Strangulation of the stomach part that has breached the diaphragm can occur. This means the blood supply to the stomach part can be cut off. This is a medical emergency.

Surgical Treatment for Hiatus Hernia

The recommended treatment for a hiatus hernia is surgery.
The surgery aims at putting the protruding stomach or esophagus part to the right place and then making the hiatus smaller.
The surgery also aims at strengthening the diaphragm muscle.
All the above surgical procedures can be performed by laparoscopic surgery technique.
If any complications like incarceration or strangulation is reported in the diagnosis, then the surgeon clears that first and then repairs a hiatus hernia.