Hiatal Hernia Symptoms - Causes and Treatment
A hiatal hernia often causes heartburn, acid reflux, and difficulty swallowing. Learn which symptoms can occur and when to seek medical advice.
Things worth knowing about "Hiatal Hernia Symptoms"
A hiatal hernia often causes heartburn, acid reflux, and difficulty swallowing. Learn which symptoms can occur and when to seek medical advice.
What Is a Hiatal Hernia?
A hiatal hernia (also called a hiatus hernia or diaphragmatic hernia) occurs when part of the stomach or another abdominal organ pushes upward through the diaphragm into the chest cavity. The diaphragm is a large, dome-shaped muscle that separates the chest from the abdomen and plays a key role in breathing. The most common form is the sliding hiatal hernia, in which the junction between the esophagus and the stomach slides up through the esophageal opening (hiatus) into the chest.
Symptoms of a Hiatal Hernia
Symptoms can vary greatly depending on the type and size of the hernia. Many small hiatal hernias cause no symptoms at all. Larger or more complex hernias, however, can lead to a range of complaints.
Common Symptoms
- Heartburn: A burning sensation behind the breastbone, often occurring after meals or when lying down.
- Acid reflux: A sour or bitter taste in the mouth caused by stomach contents flowing back into the esophagus.
- Difficulty swallowing (dysphagia): Problems swallowing solid or liquid foods.
- Chest pain: A feeling of pressure or pain in the chest that can sometimes resemble cardiac pain.
- Belching and bloating: Frequent belching, a feeling of fullness, or nausea after eating.
- Chronic cough and hoarseness: Caused by stomach acid irritating the esophagus and throat.
- Shortness of breath: In rare cases, a large hernia can press on the lungs and cause breathing difficulties.
Less Common Symptoms
- Anemia due to small bleeds in the trapped stomach tissue
- Blood in the stool (melena) in cases of mucosal injury
- Irregular heartbeat in rare cases
- Unintentional weight loss due to reduced appetite or swallowing problems
When to See a Doctor
Mild and occasional heartburn does not necessarily indicate a hiatal hernia. However, medical advice should be sought promptly if:
- Heartburn or acid reflux occurs more than twice a week
- There is difficulty or pain when swallowing
- Persistent chest pain is present (to rule out a heart attack)
- Blood in the stool or unexplained weight loss is noticed
- Shortness of breath occurs without another clear cause
Causes and Risk Factors
A hiatal hernia can be congenital (present from birth) or develop over time. Common risk factors include:
- Increased abdominal pressure: From pregnancy, straining during bowel movements, chronic coughing, or heavy lifting
- Obesity: Excess body weight increases pressure on the diaphragm
- Age: Tissue naturally weakens and loses elasticity over time
- Injury or surgery in the abdominal or thoracic region
Diagnosis
A hiatal hernia is diagnosed using several investigative methods:
- Gastroscopy (upper endoscopy): Direct visualization of the esophagus and stomach
- Barium swallow X-ray: Imaging of the digestive tract using contrast medium
- Computed tomography (CT scan): Detailed cross-sectional images to determine the exact position of the hernia
- pH monitoring and manometry: Measurement of acid levels and pressure in the esophagus
Treatment
Treatment depends on the severity of symptoms and the type of hernia:
Conservative Treatment
- Proton pump inhibitors (PPIs): Reduce stomach acid production and relieve heartburn
- Antacids: Neutralize stomach acid quickly for short-term relief
- Lifestyle modifications: Weight loss, eating smaller meals, elevating the head of the bed, and avoiding alcohol and tobacco
Surgical Treatment
In severe or complicated cases, surgery may be necessary. The most common procedure is laparoscopic fundoplication, in which the stomach is repositioned below the diaphragm and the lower esophageal sphincter is reinforced to prevent reflux.
References
- Kahrilas P.J. - Hiatus Hernia, in: UpToDate (ed.: Talley N.J.), Wolters Kluwer, 2023
- Malagelada J.R. et al. - World Gastroenterology Organisation Global Guidelines: Dysphagia (2014), World Gastroenterology Organisation
- Dent J. et al. - Epidemiology of gastro-oesophageal reflux disease: a systematic review, Gut, 2005; 54(5): 710-717
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