What is hiatus hernia? Expert lists down symptoms and treatment

Hiatus hernia can be present from birth and may also occur due to factors such as weight lifting, severe constipation, chronic cough, or in the elderly and individuals with obesity

Hiatus hernia is a condition that is more common than often realised, affecting individuals of various ages and backgrounds. This type of internal hernia occurs when the upper part of the stomach protrudes upward into the chest through a widened opening in the diaphragm. The diaphragm is a muscular sheet separating the chest from the abdominal cavity. Sometimes, it can weaken, leading to the development of a hiatus hernia. 

Dr Aparna Govil Bhasker, consultant bariatric and laparoscopic surgeon, metaheal- laparoscopy and bariatric surgery centre, Mumbai, Saifee, Apollo and Namaha Hospitals, Mumbai, says, “This condition can be present from birth and may also occur due to factors such as weight lifting, severe constipation, chronic cough, or in the elderly and individuals with obesity.” 

Types of hiatus hernia 
There are mainly two types of hiatus hernia:

1. Sliding hiatus hernia: This is the most common type of hiatus hernia. In this type, the junction of the food pipe and stomach and sometimes the upper part of the stomach slide up into the chest through the hiatal opening. This movement can lead to symptoms such as acid reflux, heartburn, and regurgitation of stomach contents into the food pipe.

2. Para-oesophageal hernia: This is a less common type where the stomach and the food pipe remain in their natural positions, but a part of the stomach may protrude through the hiatal opening. This type of hernia can lead to complications such as strangulation of stomach tissue and impaired blood supply. This can be very painful and also lead to vomiting.

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Signs and symptoms
Symptoms of hiatus hernia can vary, with some individuals experiencing no symptoms while others may have severe acid reflux. Common signs and symptoms include heartburn, acidity, swallowing difficulties, vomiting, and acid reflux. 

These symptoms may worsen when lying down or bending and improve when in an upright position. Some individuals may also experience breathlessness and asthma-like symptoms, while others may experience change in voice, and develop ulcers leading to blood in vomiting or dark-coloured stools.

Diagnosis
Diagnosing a hiatus hernia involves a comprehensive evaluation, including a detailed history and clinical examination. Various tests may be conducted, such as:

1. Barium swallow or esophagogram: This test involves drinking a barium solution that helps visualise the stomach's silhouette on fluoroscopy.

2. Upper GI endoscopy: A procedure using an endoscope to visualise the stomach and duodenum to assess the hiatal defect's size and grade.

3. 24-hour pH manometry: Measures acid pressure and movement within the food pipe.

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Treatment
Treatment for hiatus hernia includes lifestyle modifications, dietary changes, medications and surgical intervention. 

Patients are advised to eat small frequent meals, avoid spicy and oily foods, have an early dinner, and sleep with the head elevated. 

Antacid medications may provide relief for some patients. 

Surgery is recommended for those who do not respond to medications, experience complications like Barrett's oesophagus, asthma-like symptoms, or ulcers. 

Surgery for hiatus hernia
Surgery for hiatus hernia, particularly for those with symptomatic or complicated cases, may be recommended by healthcare professionals. Here is an overview of the surgical options for hiatus hernia:

Laparoscopic Nissen Fundoplication: This is one of the most common surgical procedures for hiatus hernia. It involves making several small incisions in the abdomen through which a laparoscope and surgical instruments are inserted. The surgeon makes a 360 degree wrap of the upper part of the stomach (fundus) around the lower part of the food-pipe along with tightening of the lax crura.

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Laparoscopic Toupet Fundoplication: Similar to Nissen fundoplication, Toupet fundoplication is also performed laparoscopically. In this procedure, the fundus of the stomach is partially wrapped around the esophagus, creating a 270-degree wrap instead of a full 360-degree wrap as in Nissen fundoplication.

It's important to note that the choice of surgical approach depends on various factors, including the size and type of hernia, severity of symptoms, overall health of the patient, and surgeon's expertise. Patients undergoing surgery for hiatus hernia should discuss the risks, benefits, and expected outcomes with their surgeon to make an informed decision about the most suitable surgical option.

In conclusion, consulting a healthcare professional and seeking the right treatment is essential for individuals with hiatus hernia. By understanding the symptoms, diagnosis, and treatment options, individuals can effectively manage this condition and improve their quality of life.

Disclaimer: This information does not replace professional medical advice. Consult a qualified specialist or your physician for personalised guidance.

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