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Hiatus Hernia

The diaphragm's weakest point is a small opening (hiatus) that allows the passage of the oesophagus from the chest to the abdomen. A hiatus hernia occurs when a section of the stomach protrudes through the hole into the chest cavity. 

There are two main types of hiatal hernias:

  1. Paraoesphageal hiatus hernia- occurs when the lower part of the oesophagus and upper part of the stomach stay in their locations but another part of the stomach squeezes through the hiatus, next to the oesophagus. This is the less common type of hiatus hernia.

  2. Sliding hiatus hernia- caused by the lower part of the oesophagus and the upper part of the stomach rising into the chest through the hiatus.

Causes of a hiatus hernia

  • An inherited weakness in the surrounding muscles

  • injury to the area

  • Intense pressure on the surround muscles, ie. coughing, vomiting or lifting heavy objects


Symptoms

A hiatus hernia may be asymptomatic or can cause the following symptoms:

  • Chest pain

  • Gastric reflux

  • Heartburn

  • Vomiting

  • Abdominal pain

  • Belching

Severe complications of hernia

Incarcerated hernia- The stomach may become stuck in hernia with compromised blood flow leading to gangrene and perforation of the stomach in which emergency surgery is needed.

Investigations

A hiatus hernia can be diagnosed via a gastroscopy, barium swallow or CT.

Treatment

A hiatus hernia is usually can be managed with lifestyle modifications and medications although can require surgery depending on the size of the hernia and if it is symptomatic.

  • Lifestyle- avoid large meals, spicy food, carbonated drinks, reducing weight and cease smoking

  • Medication- to neutralise stomach acidity can be used

  • Surgical- Laparoscopic hernia repair