A hiatal hernia is the protrusion of the stomach into the chest, due to the weakening of the diaphragm.
Incidence of hiatal hernias increases with age; approximately 60% of individuals aged 50 or older have a hiatal hernia. Of these, 9% are symptomatic, depending on the competence
Normally, the diaphragm serves as an external sphincter to keep the esophagus separate from the stomach at the Gastro-Esophageal Junction (GEJ). The hiatal hernia occurs as a result of a weakening in the diaphragm muscle that allows the stomach to slide up into the chest. Another risk factor includes obesity and increased intra-abdominal pressure, heavy lifting, violent vomiting, frequent coughing/sneezing.
The size of a hernia varies person-to-person. Some can be small (around 2 cm in length), but others can be large (8-10 cm’s), where a significant portion of the stomach protrudes up into the chest.
The symptoms of a hiatal hernia include chest pain or chest pressure. Some people experience severe heartburn due to reflux of gastric content from the stomach into the esophagus. This is mainly due to weakening of the sphincter which normally serves as a barrier. Some people experience difficulty swallowing, where food gets stuck inside the pouch and won’t go down, and causing chest discomfort.
The treatment varies depending on the severity of the symptoms, includes life-style modifications, medications, and rarely surgical repair.
The life-style modifications include avoiding caffeine, fatty foods, lying down in the supine position immediately after eating a meal, eating a large meal, and losing weight to decrease the intra-abdominal pressure.
Medications used are the same as the ones used for the treatment of heartburn, the so called “acid reducers.”
Surgery plays an important role in the treatment of a hiatal hernia, when symptoms are not alleviated with conservative measures discussed above. Surgery includes the repair of the diaphragmatic defect that allows the stomach to protrude up into the chest, and creating a wrap where the upper part of the stomach is wrapped around the esophagus. This procedure is done using special scopes which leaves minimal scars, and often times alleviates symptoms, and eliminates the need to take medications.