Although achalasia and hiatal hernias may seem like similar health concerns due to having a few similar symptoms, they’re actually distinct conditions that affect the esophagus and the stomach. Whereas achalasia impairs esophageal muscle function, hiatal hernias occur when part of a person’s stomach pushes up into their chest cavity.
In this article, we’ll cover the causes, symptoms, and treatment options for both of these health conditions. This will help you learn more about their impacts on digestive health and better understand when it’s time to seek support.
Understanding Achalasia
Definition and Anatomy
Achalasia is a very rare digestive disorder, affecting 8 to 12 people per 100,000. The condition is caused by damage to the nerves controlling the esophageal muscles, which results in the esophagus’s inability to properly move food into the stomach. The lower esophageal sphincter (LES), is a circular muscle located at the end of the esophagus where it joins the stomach, and it plays an important role in this process. In people who don’t have achalasia, the LES relaxes to allow food to pass through and then contracts to prevent reflux. However, in people with achalasia, the LES doesn’t properly relax, which leads to food accumulation in the esophagus and difficulty swallowing.
Causes and Risk Factors
The two types of achalasia are primary and secondary. Primary achalasia has no known cause, though immune system issues may play a role. Secondary achalasia, also called pseudoachalasia, is usually caused by cancer near or where the esophagus meets the stomach. Other causes include infections like Chagas disease or complications from surgery. In both types, the muscles and nerves in the esophagus don’t work correctly, which makes it hard for food to pass and causes difficulty swallowing, along with other digestive issues.
Symptoms
The primary symptom of achalasia is dysphagia, which makes it difficult to swallow both solids and liquids. Because of this, patients often experience regurgitation of undigested food, sometimes even hours after eating. Chest pain or discomfort is also common, although it’s often mistaken for heartburn. As the condition progresses, many patients struggle with their eating habits which leads to unintended weight loss and even potential malnutrition.
Understanding Hiatal Hernias
Definition & Anatomy
Hiatal hernias take place when a portion of a person’s stomach pushes through their diaphragm and into their chest cavity. There are two main kinds of hiatal hernias: sliding and paraesophageal hernias. Sliding hernias account for 95% of cases, and involve the stomach and lower esophagus sliding up through the hiatus. Paraesophageal hernias, on the other hand, are less common but potentially more serious. Part of the stomach squeezes through the hiatus alongside the esophagus with paraesophageal hernias, and this condition may lead to serious complications like strangulation if left untreated.
Causes and Risk Factors
Congenital or acquired weaknesses in a person’s diaphragm often lead to the development of a hiatal hernia. Common risk factors include obesity, frequent heavy lifting, chronic coughing, and the natural aging process that weakens muscle and connective tissue over time. All of these factors cause strain on the diaphragm, which lets the stomach muscles push through the weakened area more easily.
Read more: What Is the Main Cause of Hiatal Hernia?
Symptoms
One of the most common symptoms of hiatal hernias is gastroesophageal reflux disease (also known as GERD), which causes heartburn and regurgitation. People with hiatal hernias may also experience pain or pressure in their upper abdomen or chest area. Large hernias often lead to difficulty swallowing, which creates a sensation of food getting stuck in the back of the throat or chest. Other symptoms may include bloating, belching, and shortness of breath after eating. Anyone experiencing these symptoms should search for a “hernia specialist near me” to get a proper diagnosis and discuss treatment options.
Diagnostic Approaches
Diagnostic Techniques for Achalasia
Several tests are often used to diagnose achalasia:
- Esophageal manometry: Measures pressure and movement in the esophagus to see whether or not LES relaxation is impaired.
- Barium swallow X-rays: Can show a narrowed LES and dilated esophagus.
- Upper endoscopy: Helps rule out other conditions and assesses the esophageal lining for any complications.
- Functional luminal imaging probe (FLIP): Used in some cases to confirm the diagnosis if the other tests are inconclusive.
Diagnostic Techniques for Hiatal Hernias
There are a few techniques that a hernia specialist in Orange County commonly uses to diagnose hiatal hernias:
- X-rays of the upper digestive system: Help the hernia specialist in Orange County visualize the hernia’s size and location.
- Endoscopy: Allows direct viewing of the hernia and assessment of the esophageal lining for damage or complications. This procedure also helps rule out other conditions with similar symptoms.
- pH monitoring tests: Measure the acid levels in the esophagus over 24-48 hours, which helps determine the presence and severity of associated GERD.
Treatment Options for Achalasia
Non-Surgical Treatments
Pneumatic balloon dilation is also used to treat achalasia. This is a minimally invasive procedure that involves stretching out the LES using an inflatable balloon, and it’s proven helpful in enhancing many patients’ ability to swallow. All of the non-surgical approaches that we’ve outlined here are usually considered initial interventions, especially for patients who may not be suitable candidates for surgery.
Surgical Treatments
While non-surgical treatments for achalasia are usually temporary, surgical interventions provide long-term relief. Heller myotomy is a common approach to treating achalasia, and it involves making small incisions to cut the LES muscles, which allows food to pass through more easily. A less invasive technique is Peroral Endoscopic Myotomy (POEM), where the LES muscles are cut through the mouth using an endoscope, resulting in a faster recovery process for the patient. In some cases where the esophagus is severely damaged or other treatments have failed, an esophagectomy may be considered. This is a major surgery wherein the entire esophagus is removed, and it’s rarely performed due to the potential risks associated with the procedure.
Treatment Options for Hiatal Hernias
Non-Surgical Treatments
Hernias don’t go away on their own, but a hernia specialist in Orange County may recommend non-surgical treatments to help manage their symptoms. Lifestyle modifications, including weight loss, dietary adjustments, and avoiding heavy lifting, help reduce pressure on the diaphragm. For acid reflux and GERD symptoms associated with hiatal hernias, medications like antacids provide fast relief, while H2 blockers and proton pump inhibitors help with longer-term acid reduction.
Surgical Treatments
There are a few surgical approaches that hernia specialists in Orange County take to treat hiatal hernias. Nissen fundoplication is a common procedure that involves wrapping the upper part of the stomach around the lower esophagus to strengthen the LES and prevent reflux. Hiatal hernia repair is another approach that focuses on repositioning the stomach below the diaphragm and tightening the hiatus to prevent recurrence.
Many hernia specialists in Orange County also perform laparoscopic hernia repairs, which involve making small incisions and using a camera to visualize the hernia during the procedure. This is a minimally invasive procedure and typically results in shorter recovery times and less pain compared to traditional open surgery. However, in some cases, it may be necessary for the hernia specialist in Orange County to perform open surgery instead. The choice of technique ultimately boils down to the hernia’s size and the patient’s overall health.
Recovery and Long-Term Management
Post-Surgery Care
Recovery from achalasia or hiatal hernia surgery can take anywhere from 2-12 weeks, depending on the specific procedure that was performed. During this time, patients are put on a liquid diet and gradually progress to soft foods, then regular meals. It’s important to stick to dietary guidelines provided by the hernia specialist in Orange County to support the healing process. Pain management and limited activity are also crucial in the first few weeks to help prevent any complications from occurring.
Long-Term Management
Both achalasia and hiatal hernia patients should attend regular follow-up appointments with their doctor to monitor for symptom recurrence and address any concerns in a timely manner. They should also implement lifestyle changes as recommended by their doctor, such as weight management, avoiding trigger foods, and eating smaller meals.
It’s important to note that even if surgery is successful, some patients may still experience a recurrence of their symptoms over time. Sticking to dietary adjustments, taking certain medications as prescribed by the doctor, and, in some cases, repeating the procedure are all strategies to manage this.
Conclusion
Achalasia and hiatal hernias both affect the upper digestive tract, but they require different approaches when it comes to diagnosis and treatment. To manage these conditions effectively and improve patients’ quality of life, early identification and timely treatment are absolutely crucial. As we continue to see more advancements and technical innovations in the medical field, patients will hopefully have access to more effective, minimally invasive approaches to treat these conditions and support their overall health and well-being.
If you’re struggling with digestive issues, we’re here for you at Orange County Robotic General Surgery. We specialize in advanced laparoscopic and robotic procedures and offer personalized care to help you feel your best. Request a consultation today to learn more.
Contact Us
To find out if inguinal hernia repair surgery is right for you, Contact Orange County General Robotic Surgery at (714) 706-1257 for a consultation with Dr. Abtin H. Khosravi.
