The Gastrointestinal Tract (GIT) begins with the oesophagus (swallowing tube). The oesophagus lies within the chest, while the stomach lies within our abdominal cavity. A muscle known as the diaphragm separates the two organs. The oesophagus continues through an opening in the diaphragm, also known as the hiatus, into the stomach. A hiatal hernia occurs when there is a weakness of the hiatal muscles and the stomach bulges up into the chest through the hiatus.
There are two main types of hiatal hernias:
Patients may not have symptoms, and of those who do, the symptoms may vary depending on the type of hiatal hernia they have.
Patients with sliding hiatal hernias usually have symptoms that are similar to Gastroesophageal Reflux Disease (GERD). This happens when acid produced in the stomach and food residue moves up into the oesophagus, causing symptoms like:
Patients with paraoesophageal hiatal hernias experience symptoms when the blood flow to the portion of stomach trapped in the chest is compromised or when the herniated stomach presses on other organs in the chest. These include:
While the exact causes of hiatal hernia are not known, several factors may contribute to the development of hiatal hernia. These include:
A hiatal hernia is usually diagnosed via an endoscopy, where a camera attached to the end of a flexible tube is passed through the mouth into the patient’s oesophagus and stomach. A diagnosis can also be made with other imaging studies like chest x-ray, barium swallow, CT or MRI scan of the abdomen and chest.
The recommended treatment for hiatal hernia depends on the type of hiatal hernia and symptoms experienced. , No treatment is needed for patients with sliding hiatal hernia if the patient has no symptoms, and the hernia was found incidentally while being investigated for other conditions. Treatment for a patient with GERD symptoms can be classified into:
Patients with a paraoesophageal hiatal hernia would have to undergo surgery to be treated. Even if the patient does not experience any symptoms, surgery may be discussed if the patient is fit. This is due to the risk of complications that can occur with paraoesophageal hiatal hernia.
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