Introduction
- A hiatus hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity through the oesophageal hiatus.
- It is often associated with gastro-oesophageal reflux disease (GORD) and may cause heartburn, regurgitation, or chest discomfort.
- Management includes lifestyle modifications, medications, and in severe cases, surgery.
Types of Hiatus Hernia
- Sliding Hiatus Hernia
- The stomach and the lower oesophageal sphincter (LOS) slide into the chest.
- Most common type (over 90% of cases).
- Paraesophageal (Rolling) Hiatus Hernia
- The stomach pushes into the chest beside the oesophagus.
- Less common but may lead to complications like strangulation.
- Mixed Hiatus Hernia
- Combination of sliding and paraesophageal hernia.
Causes of Hiatus Hernia
- Increased Intra-Abdominal Pressure
- Chronic coughing, heavy lifting, pregnancy, obesity.
- Weakening of Diaphragmatic Muscles
- Age-related changes or congenital abnormalities.
- Trauma or Surgery
- Previous injuries or surgeries affecting the diaphragm.
- Lifestyle Factors
- Poor posture, overeating, or smoking.
Symptoms of Hiatus Hernia
- Common Symptoms
- Heartburn and acid reflux.
- Regurgitation of food or acid into the mouth.
- Difficulty swallowing (dysphagia).
- Chest pain or discomfort.
- Severe Symptoms (Rare)
- Shortness of breath (due to pressure on the lungs).
- Vomiting blood or passing black stools (indicating bleeding).
- Acute chest pain from gastric volvulus (twisting).
Complications of Hiatus Hernia
- Strangulation: Reduced blood supply to the herniated stomach, leading to tissue death.
- GORD and Oesophagitis: Chronic reflux causing inflammation of the oesophagus.
- Barrett’s Oesophagus: Precancerous changes in the oesophageal lining.
- Anaemia: Chronic blood loss leading to iron-deficiency anaemia.
Diagnosis of Hiatus Hernia
- Medical History and Physical Examination
- Focus on reflux symptoms and risk factors.
- Imaging and Diagnostic Tests
- Barium Swallow X-Ray: Visualizes the herniated stomach.
- Endoscopy: Identifies inflammation, ulcers, or Barrett’s Oesophagus.
- Manometry: Measures LOS function and oesophageal motility.
- 24-hour pH Monitoring: Evaluates acid reflux severity.
Treatment Options for Hiatus Hernia
1. Lifestyle Modifications
- Dietary Changes
- Avoid large meals, acidic foods, and caffeine.
- Stay upright for at least 2 hours after eating.
- Weight Management
- Reducing body weight can decrease abdominal pressure.
- Smoking Cessation
- Improves LOS function and reduces reflux.
- Postural Adjustments
- Elevate the head of the bed by 6–8 inches.
2. Medications
Drug Class | Example | Brand Name | Manufacturer | Cost Range |
---|---|---|---|---|
Antacids | Aluminium Hydroxide | Gaviscon | Reckitt Benckiser | $5–$15 per bottle |
H2 Receptor Blockers | Ranitidine | Zantac | GSK | $10–$20 per pack |
Proton Pump Inhibitors (PPIs) | Omeprazole | Prilosec | AstraZeneca | $10–$25 per pack |
Esomeprazole | Nexium | AstraZeneca | $15–$30 per pack |
- Antacids: Neutralize stomach acid for quick symptom relief.
- H2 Blockers: Reduce acid production.
- PPIs: Most effective for long-term acid suppression.
3. Surgical Treatments
- Nissen Fundoplication
- Wrapping the upper stomach around the oesophagus to strengthen the LOS.
- Laparoscopic Repair
- Minimally invasive surgery to reduce the hernia and repair the hiatus.
- LINX Device
- Magnetic ring placed around the LOS to prevent reflux.
4. Alternative and Supportive Therapies
- Herbal Remedies
- Ginger or chamomile tea may soothe symptoms.
- Physiotherapy
- Core-strengthening exercises to reduce intra-abdominal pressure.
Monitoring Parameters
- Monitor symptom relief and medication side effects.
- Regular endoscopy for patients with Barrett’s Oesophagus or severe GORD.
- Weight and dietary habits to evaluate lifestyle modification effectiveness.
Patient Counseling Points
- Explain the chronic nature of hiatus hernia and the importance of long-term management.
- Emphasize adherence to dietary and postural recommendations.
- Educate on the potential side effects of medications and the importance of follow-ups.
- Discuss the risks and benefits of surgical options for severe cases.
Use in Children
- Rare but may occur; conservative management is typically sufficient.
Use in Pregnancy
- Symptoms often resolve postpartum; antacids and H2 blockers are generally safe.
Use in Elderly
- Monitor for complications like anaemia or severe reflux; adjust treatments for comorbidities.
FAQs About Hiatus Hernia
Q1: What causes a hiatus hernia?
- Weak diaphragmatic muscles, increased abdominal pressure, and lifestyle factors.
Q2: Can a hiatus hernia be cured?
- Surgery can repair severe cases; mild cases are managed with medications and lifestyle changes.
Q3: Is a hiatus hernia dangerous?
- Most are not, but complications like strangulation can be serious.
Q4: What are the common symptoms of hiatus hernia?
- Heartburn, regurgitation, and chest discomfort.
Q5: How is a hiatus hernia diagnosed?
- Through barium swallow X-rays, endoscopy, and pH monitoring.
Q6: Can weight loss improve symptoms?
- Yes, reducing abdominal pressure can significantly relieve symptoms.
Q7: What foods should I avoid with a hiatus hernia?
- Spicy foods, caffeine, chocolate, and fatty meals.
Q8: Is surgery always required for hiatus hernia?
- No, most cases are managed with lifestyle changes and medications.
Q9: Can a hiatus hernia cause difficulty swallowing?
- Yes, especially in severe cases with significant oesophageal irritation.
Q10: Can stress worsen symptoms?
- Yes, stress can exacerbate reflux symptoms.
Q11: Are there exercises for hiatus hernia?
- Yes, core-strengthening exercises may help but should be done under guidance.
Q12: Can I lie down after eating with a hiatus hernia?
- No, it is best to stay upright for at least 2 hours.
Q13: How long does recovery take after surgery?
- Most patients recover within a few weeks, but complete healing may take longer.
Q14: Is it safe to take PPIs long-term?
- Long-term use is generally safe but requires monitoring for side effects like osteoporosis.
Q15: Can hiatus hernia recur after surgery?
- Yes, especially if lifestyle modifications are not maintained.