Hernia (Hiatal): What Is It, Symptoms, Causes, Types, Treatments, Surgery

A hiatal hernia is an organ displacement that affects more than 60% of people over the age of 60 years old. It often has no symptoms, and is therefore not easily diagnosed. As such, it is important to be aware of this condition as it may eventually cause inconvenience and complications.

Hernia (Hiatal): What Is It, Symptoms, Causes, Types, Treatments, Surgery
Hernia (Hiatal): What Is It, Symptoms, Causes, Types, Treatments, Surgery

Definition: What is a Hiatal Hernia?

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A hernia refers to an organ that leaves the part of the body cavity that contains it. In the case of a hiatal hernia, it is the stomach, which goes up via an orifice called the "esophageal hiatus". The esophagus and the vagus nerves pass through it, and it is located in the diaphragm. The diaphragm is the respiratory muscle that separates the thoracic cavity from the abdomen.

The passage of the stomach occurs because means of attachment become ineffective in the stomach and esophagus.

Causes: What is a Hiatal Hernia?

Hiatal hernias can appear via two forms. The first form is sliding hernia (type 1), which is a simple rise in the thorax of the abdominal esophagus and cardia (top of the stomach). This accounts for 90% of cases of hiatal hernia.

The second form is the rotation (paraesophageal hernia or type 2). In this case, the large tuberoisity of the stomach passes through the diaphragm while the bottom of the esophagus and the cardia remain in the abdominal position. More rare (only concerns 10% of cases), this form most often results from a congenital malformation or trauma.

Rarer yet, congenital hiatal hernias can result from a malformation of the diaphragm. Several abdominal viscera then pass and invade the chest, compressing the lungs and impeding the functioning of the heart.

Symptoms: How to Detect a Hiatal Hernia

The risk of having a hiatal hernia increases with age, affecting 10% of those under the age of 40, and up to 70% of people over the age of 60. Some factors also seem to increase the risk, including being overweight or obese, pregnancy, smoking, and chronic coughing.

The symptoms differ depending on the origin of the hernia. That said, it is not a disease in itself, but rather the bad positioning of an organ. It is sometimes diagnosed at random during an endoscopy or X-ray.

Slipped hiatal hernia may be the cause of the presence or aggravation of gastroesophageal reflux (heartburn). When the gastric juice is pumped back into the esophagus, this reflux gives rise to sensations of acid reflux. This can leave a bad taste in the mouth, a cough, or a sore throat. Without proper treatment, these gastric juices can eventually irritate the esophagus (esophagitis) and cause ulcers.

The hiatal hernia by rotation - or paraesophageal - presents no symptoms in most cases. When there are symptoms, the most common are chest or stomach pain, the feeling of heaviness, bloating after a meal, shortness of breath caused by compression of the lungs by the stomach, and anemia caused by bleeding (minimal but continuous). These latter symptoms are more rare.

Treatments: How to Treat a Hiatal Hernia

The treatment of a hiatal hernia consists of reducing the gastro-oesophageal reflux. To do this, several drugs will be used to limit or neutralize the acidity. This includes antacids, and H2-type antihistamines which serve to neutralize the production of acid by the stomach. When the two previous drugs have failed, proton pump inhibitors (PPIs) are used.

If reflux persists, a surgical procedure is possible that consists of resorbing the hernia and putting the stomach back in place. The operation is performed most often by laparoscopy, which allows access to the abdominal cavity without opening the belly. This will make symptoms disappear in more than 90% of cases.

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