A hernia is when part of an organ goes through an opening into a space it was not supposed to be in normally. The esophagus travels from your mouth to your stomach and goes through an opening in the diaphragm called the hiatus. In a hiatal hernia, part of your stomach pushes up through this opening (the hiatus) and into your chest. When this happens, the top part of your stomach gets exposed to different pressure changes in the chest much like a bellows and can also be pinched. Stomach acid can back up (reflux) through and up the esophagus. This may cause heartburn and other symptoms.
There are 2 types of hiatal hernias: sliding and paraesophageal. Sliding is the most common and is more of an intermittent problem. A paraesophageal hernia is less common but can be more serious if the stomach becomes twisted or stuck leading to obstruction or blood supply problems.
It is not known what exactly causes hiatal hernia to form but the process is likely based on several factors. Anything that increases the abdominal pressure like obesity, pregnancy, chronic constipation, or coughing can lead to this problem. Statistically, patients who are over 50 years old, have been or are pregnant, are or were overweight, or who smoke are at higher risk for forming a hernia. The symptoms for a hiatal hernia can look like other health conditions, but can include frequent burping, reflux/heartburn, trouble swallowing, feeling full after small amounts of food, and abdominal or chest pain. Interestingly, some chronic anemias are related to hiatal hernias and can resolve after repair.
Diagnosis of hiatal hernia includes imaging and functional testing to assess the anatomy of the hernia as well as the function of the esophagus and stomach. The tests often ordered are upper endoscopy or EGD, Esophagram (upper GI or barium swallow), and esophageal manometry. With this information, if symptoms are tolerable, no treatment may be needed, but if symptoms are troubling or if the anatomy of the hernia is concerning, a surgical repair can be recommended. This would usually include a minimally invasive approach to repair the hernia, tighten the opening in the diaphragm, and perform a wrap of the upper part of the stomach to restore normal anatomy and function of the junction where the esophagus and stomach come together.
If you or someone you know any of the symptoms listed above, Dr. Fenton and Dr. Glenn from Advanced Thoracic stand ready to help and are happy to discuss your symptoms, explain the diagnosis, and present all treatment options including surgical and non-surgical.