CONDITIONS
HIATUS HERNIA
A hiatus hernia is a condition when the upper part of the stomach or cardiac sphincter bulges through the diaphragm (a muscle separating your abdomen and chest). There are two major types of hiatus hernias:
- Paraesophageal (next to the oesophagus)
- Sliding
Sign and Symptoms
Major sign and symptoms of larger hiatus hernias include:
- Regurgitation of stomach contents (acid and food) into the oesophagus (acid reflux)
- Shortness of breath
- Difficulty swallowing
- Heartburn
- Gastrointestinal bleeding
- Chest or abdominal pain
- Passing of black stools or vomiting of blood
Causes
A hiatus hernia develops due to the weakness of muscle tissue that allows the stomach to swell and bulge up through the diaphragm. It is not yet clear why this happens. But a hiatus hernia might be caused by:
- Being born with an unusually large hiatus i.e., genetic
- Age-related changes in your diaphragm
- After trauma or certain types of surgery
- Increase intra-abdominal pressure on the surrounding muscles, such as exercising, lifting heavy objects, straining while passing stools, vomiting, coughing.
Diagnosis
A hiatus hernia has usually an accidental diagnosis when a patient presents with heartburn or upper abdominal pain due to any cause. These tests or procedures include:
- Oesophageal manometry
- Upper endoscopy
- X-ray chest and abdomen
Treatment
A hiatus hernia is usually non-symptomatic in most people and they won’t need any treatment. However, in larger hiatal hernia with recurrent acid reflux and heartburn, you may need medication or surgery.
Medications
If you experience acid reflux and heartburn, your doctor may recommend:
Antacids that neutralise stomach acid
- Gaviscon
- Gelusil
- Maalox
- Pepto-Bismol
Medications to reduce acid production (H-2-receptor blockers)
- Ranitidine (Zantac)
- Cimetidine (Tagamet famotidine (Pepcid)
- Nizatidine (Axid )
Medications that heal the local tissue and block acid production (proton pump inhibitors)
Surgery
Sometimes a hiatus hernia may require surgery, provided that it is not treated with medications, symptoms are worsening or have complications such as narrowing of the oesophagus or severe inflammation. This surgery may involve pulling the stomach down into the abdomen and removing the hernia sac, reconstructing an oesophageal sphincter and making an opening in your diaphragm smaller.