What Is a Hiatal Hernia?

If you experience acid reflux, or a burning, gnawing pain in your stomach or chest area after eating or drinking, you may have what’s known as a hiatal hernia. The condition is extremely common and, most of the time, non life-threatening.

 

A hiatal hernia develops when the stomach forces its way into the chest through an opening (hiatus) in the diaphragm. The diaphragm is a muscle that separates the chest from the abdomen. Normally, hiatal hernias are small enough not to cause any noticeable discomfort or symptoms. But if your suspected hiatal hernia is bothering you, it might be bigger than you think and require immediate medical attention.

The Dangers of Hiatal Hernias

Hiatal hernias can be dangerous if left untreated. Hiatal hernias can grow so large that they make the opening in the diaphragm larger. The larger the gap, the greater the risk of your stomach and other organs sliding into your chest. The longer a hiatal hernia is present, the greater the likelihood of it growing and exerting pressure on the stomach.

Large hiatal hernias can be painful and difficult to manage independently. They stimulate stomach acid activity which causes it to backflow into the esophagus. In some cases, hiatal hernias can cause ulcerative conditions. It’s not unusual for people with hiatal hernias to develop stomach ulcers and anemia.

Types of Hiatal Hernias

Sliding and paraesophageal are the two most common types of hiatal hernias. Although they can occur anywhere in the body, the most common places are in the abdominal and groin areas. Although sliding and paraesophageal are the most often used terms for diagnostic purposes, they are also classified as types to denote their severity.

Type I hernias are the most commonly diagnosed amongst hernia patients. They are also known as sliding hiatal hernias. Sliding hiatal hernias are generally small, but they do vary in size.

These kinds of hernias cause the stomach to slide up through a small opening in the diaphragm into the chest cavity repeatedly. Symptoms may or may not occur. Sliding hiatal hernias usually do not require treatment. Some patients manage their condition with positive lifestyle changes.

Types II, III, and IV hiatal hernias are paraesophageal hernias. These kinds of hernias are less common, but their symptoms are often more severe. Paraesophageal hernias develop when a part of the stomach bulges into the chest cavity near the esophagus. Instead of sliding in and out of the hiatus, the stomach becomes trapped.

Surgery is often recommended for patients with hernias this severe. It’s the most effective treatment that not only repairs the hernia site to alleviate symptoms and discomfort, but it also reinforces the connective tissues in the abdominal wall and diaphragm to prevent the hernia from recurring.

Paraesophageal hernias are more dangerous than other types of hiatal hernias. The symptoms they cause are usually more severe and troublesome to manage, and the risk of complications is much higher. Untreated, type II, III, and IV hernias can prevent normal blood flow to the stomach, causing strangulation.

Sliding hiatal hernias, on the other hand, are far more prevalent and less dangerous. Type I hiatal hernias develop when part of the stomach up into your chest through the hiatus. A significant difference between sliding hiatal and paraesophageal hernias is the former can happen over and over again. The latter causes the dislocated portion of the stomach to become stuck in the chest.

Hiatal Hernia Symptoms

Mild hiatal hernias are usually asymptomatic. Symptoms are triggered by abnormal changes in stomach acid or bile activity. Some people are unaware of their condition until they seek out medical attention for other health concerns.

On the other hand, some experience symptoms so frequently or severely that they interfere with their daily functions and well-being.

Hiatal hernia symptoms can be acute or chronic and include the following:

• Heartburn
• GERD (gastroesophageal reflux disease)
• Chest pain
• Bloating
• Burping
• Trouble swallowing
• A bitter or acrid taste
• Vomiting
• Upset stomach or nausea
• Acid reflux
• Shortness of breath
• Feeling full after eating small amounts of food
• Abdominal bleeding
• Blood loss (anemia)

Some describe their symptoms as a painful, squeezing, and twisting sensation that comes and goes without warning. While these signs can occur intermittently, they are usually quite severe.

Below are some warning signs of possible obstruction or strangulation that warrant emergency medical attention.

• Severe pain in the abdomen, stomach, or chest
• Vomiting
• Inability to pass gas or belch

Hiatal Hernias: Causes and Risk Factors

Not much is known about what causes this type of hernia except that it involves weakened or damaged muscles and connective tissues in the impacted area. Hiatal hernias are common and become even more so with age, especially for those 50 years and older. Below are some additional risk factors.

• Weak abdominal muscles
• Rapid changes in weight
• Obesity
• Smoking
• Pregnancy
• Strenuous lifting
• Coughing
• Vomiting
• Bowel movements
• Injury
• Congenital abnormality or defect

Hiatal hernias are treatable. Treatment is often recommended for those experiencing symptoms or significant discomfort. Hiatal hernia medications include H2 blockers or proton pump inhibitors to regulate stomach acid activity and antacids to neutralize or weaken gastric acidity.

Medications are designed for short-term use and are not an effective long-term treatment for hiatal hernias. There are risks associated with H2, antacids, and proton pump inhibitors. Also, not everyone has favorable results with those medications.

Hiatal Hernia Surgery

Hernias can recur long after they’ve gone away. Surgery is the most effective treatment for hernias because it relieves symptoms, repairs bulges, and prevents reflux and complications. Most patients eventually undergo surgery for immediate and long-term symptom relief and to prevent their hernias from redeveloping in the future.

Surgery for hiatal hernias consists of conventional and minimally invasive treatments.

Minimally Invasive Hernia Repairs utilize laparoscopic surgical instruments, practices, and an advanced surgery robotics system. To successfully repair a hiatal hernia, Dr. Abtin Khosravi, M.D., FACS, makes incisions into the abdominal area. Abdominal surgery is a major procedure that carries unique risks when performed with conventional or open surgical practices.

Laparoscopic hiatal hernia repair techniques and an advanced robotic surgery system make hernia repair surgery much safer and more effective for patients. These practices are also standard for the different types of hernia repair surgeries performed today. As beneficial as minimally invasive hiatal hernia surgery is for patients, it’s not suitable for all. Some are better candidates for alternative or conventional/open hernia surgery.

To learn more about hiatal hernias and treatments suitable for your situation, contact Orange County Robotic General Surgery clinic at (714)-541-4996

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