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:
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.
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
A hiatus hernia may be asymptomatic or can cause the following symptoms:
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.
A hiatus hernia can be diagnosed via a gastroscopy, barium swallow or CT.
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