What is a hiatal hernia?
A hernia is an abnormality where an organ protrudes into a different compartment than where it is supposed to be located. In the case of a hiatal hernia, there is a protrusion of parts of the digestive system from the abdominal cavity to the chest through a defect in the diaphragm. The diaphragmatic defect can be congenital and widen over time or develop secondarily to trauma. Additionally, there may be a component of increased intra-abdominal pressure (see below). The most common type of hiatal hernia is the sliding hiatal hernia, which occurs in the area where the esophagus passes through the hiatus into the abdominal cavity.
There are several types of hiatal hernias:
- Sliding Hiatal Hernia: This condition involves direct upward movement of the gastroesophageal junction into the chest. It is the most common and considered the simplest form, but it can still cause significant reflux and inflammation in the esophagus.
- Paraesophageal Hernia: This condition occurs when a portion of the stomach herniates alongside the esophagus through a separate opening. It is rarer but more severe because it carries a risk of strangulation.
- Combination of both types.
How is a hiatal hernia diagnosed?
The diagnostic process includes evaluating the medical history and performing imaging studies such as chest X-ray, upper gastrointestinal endoscopy, barium swallow, or manometry. However, hiatal hernias are often incidentally diagnosed during chest X-rays conducted for other reasons.
What causes a hiatal hernia?
Possible factors contributing to hiatal hernias include:
- Chronic cough
- Frequent vomiting
- Straining during bowel movements
- Sudden or repetitive physical exertion
- Obesity and pregnancy can also exacerbate this condition.
Treatment for hiatal hernia
The decision to treat a hiatal hernia depends on the type of hernia, symptoms, the patient's medical condition, and their preference. The treatment plan may involve medication that can reduce acid reflux or enhance the strength of the lower esophageal sphincter. Surgical intervention is primarily considered when there is a risk of strangulation due to compromised blood supply to the tissue.