A Hiatal hernia, popularly also called Diaphragmatic hernia known, occurs when part of the stomach pushes through the diaphragm into the chest cavity. In most cases, a hiatal hernia will go undetected and not cause any problems. In more severe cases, treatment up to and including surgery may be required.
What is hiatal hernia?
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The diaphragm has a small opening (hiatus) through which the lower part of the esophagus opens into the stomach below the diaphragm. In the most common cases (90-95%) one Hiatal hernia If the upper stomach moves through the diaphragm into the chest cavity (sliding fracture or axial hiatal hernia), the diaphragm no longer closes the esophagus and stomach acid flows back (reflux).
In the so-called paraesophageal hiatal hernia, part of the stomach pushes through the hiatus and in the worst case lies entirely in the chest cavity above the diaphragm. Other types of hiatal hernia are mostly lighter forms and rarely cause discomfort. The likelihood of a hiatal hernia increases with age; around 60% of all people aged 50 or older are affected.
causes
The causes of a Hiatal hernia are not fully clarified. Above all, pressure on the stomach is assumed to be a major factor. The diaphragm is a large dome-shaped muscle that separates the chest from the abdomen.
Hiatal hernia occurs when the muscle tissue around the opening that allows the esophagus to pass through to the stomach becomes fatigued. This can be caused directly by injuries to the diaphragm, but also by anatomical disorders (e.g. excessively large hiatus).
A sustained strong pressure on the surrounding muscles is e.g. caused by coughing, excessive vomiting, pregnancy or exertion during bowel movements and when lifting heavy objects. Increasing age and obesity are other risk factors for a hiatal hernia.
Symptoms, ailments & signs
Depending on the type of hiatal hernia, various symptoms and complaints can occur. The axial sliding hernia usually runs without any clear signs. Some sufferers have the typical symptoms of reflux disease. Heartburn, belching of air, difficulty swallowing and the regurgitation of food residues occur. In the case of paraesophageal hernia, the disease takes a rapid and usually severe course.
In the first stage there are usually no symptoms. In the uncomplicated stage, those affected suffer from belching and an increasing feeling of pressure in the area of the heart. The symptoms increase after eating and worsen as the disease progresses. Serious complications, such as bleeding, entrapment, or severe stomach pain, can occur at the complication stage.
In severe cases, a stomach ulcer forms, which can manifest itself as stomach cramps and severe discomfort. A hiatal hernia can also lead to anemia and the associated poor performance, paleness and palpitations. Acute bleeding can also occur in the last stage of the disease.
However, life-threatening complications rarely arise. A hiatal hernia cannot be seen externally. However, sweating, pale skin, and sunken eyes indicate an illness that needs to be investigated and clarified.
Diagnosis & course
Hiatal hernia resembles many diseases in its symptoms and is therefore rarely diagnosed directly. For example, a sick person may experience dull chest pain, shortness of breath (the rupture affects the diaphragm), palpitations (caused by irritation of the vagus nerve), or difficulty swallowing.
In most cases, a hiatal hernia itself is unlikely to cause any discomfort. Pain and discomfort are often caused by reflux of stomach acid, air, or bile caused by a hiatal hernia (heartburn).
Diagnosing a hiatal hernia is typically done through pre-arranged exams to determine the cause of heartburn or upper abdominal pain. This can be done using an X-ray of the upper digestive tract with test fluid or an endoscopy, in which a thin tube with a light and video camera (endoscope) is guided into the stomach.
Complications
A hiatal hernia can result in a variety of complications. It is not uncommon for an axial sliding hernia, also known as a sliding fracture, to cause gastric acid to flow back. This in turn creates the risk that ulcers will develop on the esophageal lining. In some cases, these ulcerations also cause bleeding.
If a horizontal position is taken while sleeping, in severe cases the stomach contents can flow up towards the esophagus. Sometimes the patient inhales the contents of the stomach or suffers from hoarseness. In addition, bronchial asthma can be exacerbated.
Complications caused by a paraesophageal hernia are particularly uncomfortable with a diaphragmatic hernia. If the stomach twists in the chest cavity and the diaphragmatic gap narrows, this makes it more difficult for the food to be transported. This disturbance of passage becomes noticeable through swallowing difficulties or vomiting in the morning hours.
If it is a large hiatal hernia, it is possible that the upper part of the stomach is pinched and bleeding occurs as a result. Due to the chronic blood loss, there is a risk of anemia (anemia). The dangerous complications of the diaphragmatic hernia include circulatory disorders in the trapped stomach.
This process sometimes leads to serious sequelae such as a gastric rupture (perforation) or inflammation of the peritoneum (peritonitis), which can be life-threatening. There is also a risk of complications with an operation on the hiatal hernia. These are mostly flatulence, injuries to the viscera, and bleeding.
When should you go to the doctor?
If the person concerned suffers repeatedly from heartburn or has to burp regularly, it is advisable to ask a doctor to clarify the symptoms. Symptoms of the act of swallowing are considered unusual. If the food has already been sufficiently chopped up in the mouth, difficulties in swallowing should be examined by a doctor. If the complaints lead to a refusal to eat or drink, a doctor is required. A feeling of internal dryness is cause for concern, as the patient is at risk of dehydration and thus a life-threatening condition.
In severe cases, an emergency doctor must be called. If there is pain in the stomach or the abdominal region, it is advisable to consult a doctor. Pain reliever medication should only be taken in consultation with a doctor. There may be side effects that contribute to further deterioration in health. If the person has to regurgitate regularly ingested food with a knee-jerk feeling, this is unusual.
The observation should be medically clarified and treated. If you have heart problems, a high pulse or increased heart activity, a doctor's visit is advisable. If you have trouble sleeping, sweat or a general feeling of illness, a doctor is needed. If bleeding occurs during stool or urination, a medical examination should be initiated immediately.
Doctors & therapists in your area
Treatment & Therapy
In most cases of Hiatal hernia patients experience no discomfort and no action is required. Treatment is primarily aimed at reducing the symptoms caused by hiatal hernia.
The drugs used are intended to neutralize stomach acid (antacids), reduce acid production (H-2 receptor blockers) or heal damaged tissue. A hiatal hernia may require surgery in a small number of conditions. This is especially true for emergencies and patients who cannot be helped by medication.
Surgery is recommended, especially in the case of a gastroesophageal hiatal hernia, since chronic reflux can seriously damage the esophagus and, in the worst case, lead to esophageal cancer. During an operation, the stomach is pulled back into the lower abdominal cavity and the opening in the diaphragm is made smaller.
Lifestyle changes can also help relieve symptoms of a hiatal hernia. Small meals throughout the day and a generally healthy, alcohol-free lifestyle are basic recommended measures. Symptomatic patients should sleep with their heads elevated and avoid a recumbent position immediately after meals. Other recommendations for living with a hiatal hernia are stress-relieving relaxation techniques and reducing obesity.
You can find your medication here
➔ Medication for heartburn and bloatingOutlook & forecast
The prospects for a diaphragmatic hernia can be assessed as very good. In over three quarters of all cases, no therapy is necessary. Then doctors speak of sliding hernias. They run without any discomfort. Otherwise, with the help of drugs, the characteristic symptoms can be eliminated. If it comes to an operation, 90 percent of the patients can continue to live without symptoms. In this context, the scientific situation can be classified as favorable.
Newborns represent a risk group. Their lung volume is often limited. If you have to perform an operation, it is not uncommon for every second small child to die. The outlook for patients in whom the diaphragmatic hernia recurs is also rather unfavorable. However, this rarely happens. The texture of the fabric is also unsuitable in very few cases. Then not all symptoms can be eliminated.
The hiatal hernia must run smoothly during the surgical procedure. If complications arise, severe damage to the body is often revealed. Inflamed tissues and released toxins are just some of the negative consequences. As a result, normal participation in everyday life is no longer possible.Many sufferers die a short time after such surgical therapy.
prevention
There one Hiatal hernia especially caused by increased pressure in the abdomen, heavy lifting or other mechanical influences should be avoided. In order to counteract internal stress, care should be taken to maintain a healthy intestinal flora to avoid constipation.
Aftercare
If conservative treatment using medicinal acid inhibition with proton pump inhibitors has been successful or if surgical treatment has been performed after recurrent reflux esophagitis and the patient is symptom-free and symptom-free, no postoperative treatments are necessary. Repeated follow-up examinations can also be dispensed with if the symptoms are free and the previous symptoms are absent.
A one-time check-up by the surgeon is usually sufficient. If, however, reflux symptoms or an associated reflux esophagitis occur, a new upper endoscopy, manometry and pH-metry are recommended. Immediately after a hiatoplasty, the transition zone between the esophagus and the cardia of the stomach is still swollen and irritated.
Therefore, it is advisable to avoid solid food in the first few days after the procedure. Since the lower esophageal obstruction is significantly narrowed during surgical therapy compared to the preoperative situation, minimal swallowing difficulties can remain as permanent complaints, as well as slight gastrointestinal symptoms (flatulence, diarrhea, restrictions or inhibitions in the event of vomiting or belching).
In order to prevent these secondary symptoms, attention should be paid to diet postoperatively and especially during the recovery period. It is advisable to optimize the diet with regard to personal intolerance and any other factors (digestibility, consistency) and, in addition, to allow enough time for food intake, to chew thoroughly and to drink and eat separately.
You can do that yourself
In parallel to medical treatment, a hiatal hernia can be treated by yourself using various tips and measures. Above all, a change in lifestyle helps relieve symptoms.
A healthy and balanced diet without alcohol, caffeine and other stimulants is recommended. Since a hiatal hernia is often triggered by too much stomach acid, acid-producing foods (e.g. salt, sugar, dairy products and fried foods) should be avoided. Alkaline products such as cucumber, celery, carrots, grapes and red fruits are suitable. Food should be consumed in small meals spread over the day. Overweight people have to reduce their body weight over the long term in order to correct a diaphragmatic hernia. Furthermore, the avoidance of stress applies, which can be achieved through targeted relaxation measures. Those affected should also sleep with their heads raised and, if possible, not lie down after meals.
Furthermore, drugs such as aspirin should be avoided, as these lead to an increased pH value. Medicines containing estrogen or progesterone can weaken the hiatus muscles and should therefore not be taken. If the symptoms do not subside despite the above measures, it is best to consult a doctor.
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