The diaphragm is a wall made of muscle that divides the thoracic cavity from the abdomen. A hiatus is the opening in the diaphragm through which the esophagus runs and connects to the stomach. A Hiatal Hernia is also known as: a Sliding Hernia or a Paraesophageal Hernia. In a Sliding Hiatal Hernia (which is most often seen), the area where the esophagus and the stomach connect becomes trapped within the hiatus of the diaphragm, which can cause enlargement of the hiatus, or opening. A hiatus in another region of the diaphragm can also abnormally develop. In a Paraesophageal Hiatal Hernia, a portion of the upper stomach herniates through the hiatus, causing the bulging region of the stomach to lie next to the esophagus. As a result, one can develop a loss of blood circulation to the area, which can be critical as it can cause tissue death.
Risk Factors for developing a Hiatal Hernia are obesity, being older than fifty years old (more commonly in women), smoking, having a physical injury to the area (such as from straining from coughing or from heavy lifting), and pregnancy. Others may be born with the condition. The two main diagnostic tests used to diagnose a Hiatal Hernia are an upper Gastrointestinal Series using Barium and an Endoscopy, performed by a Gastroenterologist. Some people are asymptomatic and have no symptoms with a Hiatal Hernia. However, others may experience intense chest pain, bloating, reflux of stomach acid and content, nausea, gas, symptoms of an Obstruction, and or heartburn. Many people with a Hiatal Hernia may also have Gastroesophageal Reflux Disease (GERD), and may have symptoms reflective of GERD.
Lifestyle modifications can alleviate mild cases of a Hiatal Hernia including: eating smaller and frequent meals, losing weight, avoiding highly acidic foods and beverages, not smoking, eating earlier meals, and elevating one’s head by a six inch wide plank of wood under the headboard of the bed when lying down. Over-The-Counter Antacids may also reduce symptoms in mild cases of a Hiatal Hernia, or Proton-Pump Inhibitors may also be used.
If a Paraesophageal Hiatal Hernia becomes strangulated when the stomach becomes entrapped in the hiatus, surgery may be necessary to release the hernia. A Metal Mesh may be placed along any abnormal openings in the diaphragm. In addition, for a complete obstruction caused by a Hiatal Hernia, surgery is most often the form of treatment. For people who have severe cases of Gastroesophageal Reflux Disease (GERD), and have intense symptoms, a Nissen Fundoplication Surgery is most often used as the form of treatment. A Nissen Fundoplication Surgery is usually performed to prevent Reflux by tightly wrapping the stomach around the distal end of the esophagus. Laparoscopic surgery is most often the choice of surgery (when possible), as it usually less invasive in scarring, minimizes Recovery Time with pain, and leads to less complications compared to Open Surgery.