Hiatal hernia or diaphragmatic hernia

A hiatal hernia or diaphragmatic hernia occurs when parts of the stomach move into the chest through an opening in the diaphragm called a hiatus.

The diaphragm is a large, dome-shaped muscle that separates the thoracic and abdominal cavities.

A diaphragmatic hernia in most cases does not cause symptoms, nevertheless the occurrence of heartburn and gastroesophageal reflux is favored.

Hiatal hernia is common in the elderly, with 30% of people over fifty years of age suffering from it.
This proportion may be even greater, because many people with diaphragmatic hernia have very mild or no symptoms, and often do not know about it.


Forms of a hiatal hernia

Axial sliding hernia The axial sliding hernia (axial hernia, sliding fracture) is the most common form of hiatal hernia
at 80%; The stomach entrance with the junction between the esophagus and stomach, the so-called lower esophageal sphincter, shifts through the diaphragm upwards into the chest cavity.

The stomach entrance can remain in the chest for a longer period of time, but usually the displacement is short-lived. Axial sliding occurs because the muscles of the esophagus tense when swallowing and pull the stomach upwards. When the swallowing process is finished, the leaked part of the stomach slides back into the abdominal cavity.

Paraesophageal hernia
The paraesophageal hiatal hernia is characterized by the anatomically correct location of the lower esophageal sphincter (sphincter of the esophagus), but part of the stomach pushes from below next to the esophagus into the chest cavity.

In a pronounced form, paraesophageal hiatal hernia of food can block the way into the stomach, especially if the esophagus is compressed, it can cause reflux of food into the esophagus. Peptic ulcers can also form in a displaced stomach.
Fortunately, large paraesophageal hiatal hernias are rare.

Causes of hiatal hernia

The exact reasons why a diaphragmatic hernia develops are currently unknown, but in people over fifty, smokers and overweight people, the probability is very high.

Other factors that increase the risk of diaphragmatic hernia include:

  • severe coughvomiting or exertion during sports;
  • weakened diaphragm, in the course of the normal aging process;
  • surgery performed in the past for hiatal hernia.

A diaphragmatic hernia is more common in women than in men. Women often have reflux symptoms in pregnancy because the pressure in the abdomen increases as the child grows.
Diseases such as chronic inflammation of the esophageal mucosa (esophagitis) can lead to shortening of the esophagus and increase the risk of hiatal hernia.

A diaphragmatic hernia is not caused by worry and anxiety, but related ailments, such as gastroesophageal reflux, can be caused or exacerbated by worry, grief, guilt, and stress.

What are the symptoms of a hiatal hernia?

Often a hiatal hernia occurs symptom-free.

Symptoms due to reflux of gastric acid
The diaphragmatic hernia itself does not cause any discomfort. But due to the hernia, the functioning of the closure mechanisms that prevent stomach acid from flowing back into the esophagus may be disrupted. The sphincter may not close completely and the normal pressure of the diaphragm in the esophagus decreases.
So it can easily happen that stomach acid flows into the esophagus.
The stomach acid can cause inflammation of the inner wall in the esophagus, which can cause one or more of the following symptoms:

The leading symptom is heartburn. It arises in the upper abdominal or lower chest region and reaches up to the neck. (It’s confused, but has nothing to do with the heart!)

Like heartburn, these symptoms come and go and are usually stronger after a meal.

You may also experience some rare symptoms.
If any of these symptoms become noticeable, diagnosis may be difficult because it can indicate other conditions.

For example:
Sometimes a persistent cough occurs, especially at night. This is caused by the stomach acid-related irritation of the esophagus.
Other possible ailments affecting the mouth and throat include gum problemsbad breath, sore throat, hoarseness and the feeling of a lump in the throat.

XJ Hiatal Hernia Diaphragmatic Glide

Note: Most people with gastric acid reflux do not have a diaphragmatic hernia and most people with diaphragmatic hernia do not have reflux symptoms.
So it is not said that in a hiatal hernia, the sphincter between the esophagus and stomach functions to a limited extent. It only increases the likelihood of dysfunction of the esophageal sphincter and thus of gastric acid reflux with the associated symptoms.

Those who have a hiatal hernia and suffer from reflux usually have more severe complaints.
The reason for this is that with a hit hernia, the stomach sow has a greater chance of staying in contact with the inner wall of the esophagus.

What complications of hiatal hernia can occur?

Possible complications of reflux of stomach acid into the esophagus include:

Stenose. Severe and long-lasting inflammation can lead to scarring and narrowing of the lower esophagus. This complication is rare.

Barret’s esophagus. In this disease, the cells of the inner lining of the lower esophagus change. The altered cells have a higher probability of becoming malignant.
About 1-2 out of 100 people with Barret syndrome develop esophageal cancer.

Cancer. The risk of developing esophageal cancer is slightly increased if gastric acid reflux persists for a long time.

Other complications include:
· anemia due to bleeding in the esophagus, the blood may be contained in the vomit or stool;
· ulcer (ulcer) at the level of the esophagus;
· the acid reflux can get into the lungs and cause chronic cough, difficulty breathing, asthma and, in rare cases, pneumonia.

How is hiatal hernia diagnosed?

First of all, it is necessary to consult a doctor so that the cause of the symptoms can be determined.
The doctor will palpate, listen and tap the upper body to analyze the consistency and sounds emitted by the abdomen.
Then the mobility of the stomach must be assessed to determine whether adhesions or very tight structures interfere with movement.

Hiatal hernias are often diagnosed as an accidental diagnosis when a gastrointestinal X-ray or upper laparoscopy is performed for discomfort in the upper gastrointestinal section or pain in the upper abdomen.
On X-ray and laparoscopy, the hiatal hernia appears as a separate sac, which lies between the esophagus and stomach.
It is possible that the hernia is visible only when swallowing.

Treatment of hiatal hernia

Treatment for a hiatal hernia is aimed at relieving symptoms. The family doctor or internist may prescribe pharmacological treatment and give nutritional advice. In rare cases, surgery is required.

Natural home remedies

By changing certain lifestyle habits, the symptoms of a diaphragmatic hernia can be alleviated and related problems prevented.

    • In case of overweight and obesity, a diet should be followed to get rid of the excess pounds.
    • Often eat smaller meals and do not eat immediately before bedtime.
  • Refrain from smoking and alcoholic beverages.
  • Wear comfortable, not too tight-fitting clothing.
  • Place your head higher while sleeping.
  • Limit the consumption of acidic, caffeinated, sweetened or carbonated beverages, such as orange juice, coffee and energy drinks.
  • Some foods should be avoided, such as onions, chocolate, spicy or fatty foods.
  • Exercise and fitness training are generally recommended, but exercises to strengthen the abdominal muscles should be avoided because it increases the pressure on the abdomen, which can increase the hernia.

Osteopathy can be used helpfully to release tension that blocks the movements of bones and organs; in this way, the functioning of the stomach and digestion is improved.

Medication for hiatal hernia

There are various medications that can reduce the symptoms of a hiatal hernia. These include acid-neutralizing agents (antacids, e.g. Maalox), the effectiveness of which varies from person to person. If the symptom-relieving effect is insufficient, the doctor can change the drug.

Surgical intervention for diaphragmatic hernia

When is surgery performed?
A small percentage of hiatal hernias require surgical treatment. Surgery is usually limited to emergencies and people who cannot take the medications to relieve heartburn and reflux.
Surgery to repair the diaphragmatic hernia is often performed in combination with surgery for gastroesophageal reflux disease.

Fundoplication according to Nissen-Rossetti: In this surgical procedure, parts of the gastric fundus are loosely wrapped around the lower esophagus. In this way, the lower sphincter of the esophagus is supported and the reflux of stomach contents into the esophagus is less likely.

Surgical intervention for hiatal hernia can follow the following surgical principles:

  • displacement of the stomach downwards into the abdomen,
  • reduction of the gap in the diaphragm,
  • Reconstruction of a weak sphincter or removal of the upturned part of the stomach.

The chest cavity (thoracotomy) or abdominal cavity (laparotomy) can be opened with a single incision.
Or as part of a minimally invasive procedure, the surgeon inserts a small camera and special surgical instruments through small incisions in the abdominal wall (laparoscopy).
The doctor performs the procedure while the images from inside the body are displayed on a screen (laparoscopic surgery).

The patient must remain in the hospital until about three days after the procedure.
After a minimally invasive procedure, professional activities can be resumed 2 to 3 weeks later.
After an open surgical procedure, recovery times are usually longer.

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