Hiatal hernia

May 2017

A hiatal hernia is the shift of part of the stomach from the abdomen toward the thorax through a natural hole in the diaphragm. The symptoms are often represented by pain located on the upper part of the abdomen or chest, a burning sensation in the sternum which seems to move upward, a nocturnal cough, and difficulty swallowing. Confirmation of the diagnosis is made by an esophagogastric endoscopy to visualize the hernia. Treatment addresses the symptoms by reducing gastric acidity through diet, excluding alcohol and acidic or spicy foods, and medications to fight against this acidity. Surgery replacing the displaced portion of the stomach may be necessary if symptoms persist.


Definition

A hiatal hernia is formed by the passing of a portion of the stomach into the chest through an orifice in the diaphragm that is abnormally large. It is similar to another type of hernia, a Bochdalek hernia, but in the latter case the stomach goes through an orifice that isn't supposed to be present. This movement of the stomach is due to an increase in pressure at the abdomen, a disorder of the esophagus, an injury or obesity.

Symptoms

A hiatal hernia is sometimes asymptomatic and therefore discovered accidentally. Symptoms that point to a hiatal hernia are often those associated with gastro-oesophageal reflux:
  • the gastric fluid moves up to the esophagus. This creates a feeling of heartburn;
  • pain in the upper abdomen;
  • food regurgitation, especially after meals;
  • burping, hiccups, nausea;
  • coughing, especially at night;
  • difficulty swallowing (dysphagia).

Diagnosis

The diagnosis of hiatal hernia is confirmed with an endoscopy (to visualize the esophagus and the stomach wall), a chest X-ray (used to locate the position of the stomach portion that migrated into the chest). A review of transit in the esophagus (UGI) is sometimes also performed.

Treatment

The treatment will be symptomatic. It is usually to reduce gastroesophageal reflux. Some dietary hygiene measures will be taken:
  • split meals (up to 6 per day) into smaller quantities;
  • adopt a balanced diet;
  • Avoid acidic or spicy food and alcohol.


Drugs that fight against acidity such as antacids or alginates are frequently prescribed to be taken after meals. Other drugs called antisecretory drugs also reduce gastric acidity.
In some types of hernia, or when the reflux is too severe, a doctor will proceed with a surgical procedure that will put the portion of the intrusive stomach abdominal back into its normal position.

Related

Original article published by . Translated by Jeff. Latest update on November 10, 2016 at 06:37 AM by Jeff.
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