Hiatal Hernia

A hernia is a protrusion of part of an organ through the muscle wall that surrounds it. A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the structure that separates the stomach from the chest. A hiatal hernia results in retention of acid and other contents above this opening. These acids and other substances can easily back up (reflux) into the esophagus.

Esophageal abnormalities or a larger-than-normal opening of the diaphragm where the esophagus passes through to the stomach is thought to predispose some people to this problem. Many people age 50 and over have small hiatal hernias; however, hiatal hernias may affect people of all ages.

Sudden exertions of certain kinds, in people disposed to this condition, are thought to increase the likelihood of hiatal herniation:

• coughing;
• vomiting;
• straining;
• or sudden physical movements

Obesity and pregnancy can also increase risk for this problem.

Most people who have hiatal hernias have no symptoms. But the larger the hernia the more likely it is to cause symptoms.

The primary symptom of hiatal hernias is gastroesophogeal reflux.

In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose hiatal hernia:

• upper GI x-ray;
• or upper endoscopy.

Hiatal hernias usually do not require treatment. But treatment may be necessary if the hernia is:

• in danger of becoming strangulated (twisted in a way that cuts off blood supply to the protruding stomach tissue);
• complicated by severe gastroesophageal reflux disease (GERD);
• complicated by esophagitis (inflammation of the esophagus).

Treatment is usually the same as that for GERD. But surgery may be needed in these cases to reduce the size of the hernia, or to prevent its strangulation.