Hiatus hernia or ‘diaphragmatic hernia’ is a condition that develops at the place where the esophagus meets the stomach (diaphragm). It occurs due to an abnormality in the muscles of the diaphragm. The diaphragm separates the muscles of the chest from the muscles of the abdomen. In hiatus hernia, the opening of the diaphragm (known as ‘hiatus’) is large, resulting in the protrusion of the stomach wall and its contents into the chest. The individual can develop several symptoms including heartburn, chest pain, acid reflux, twisting of the intestines and stomach (voluvlus), dysphagia, obstruction of the lumen of the esophagus, etc.
The symptoms usually worsen during pregnancy and performance of certain tasks such as exercising, bending, lifting heavy loads, straining, etc. The individual should seek medical care once the symptoms of heartburn are severe, persistent and complicates other pre-existent conditions (such as asthma and tonsilitis). The diagnosis of hiatus hernia is made based on the history, symptoms, signs, physical examination, barium meal study and endoscopy (Mayo, 2006, NY Presbyterian Hospital, 2007, Mishra, 2007 & UW Health, 2006).
If the symptoms are mild, treatment is usually not required. However, if the symptoms of reflux are persistent and severe, the individual should receive immediate medical care. Some of the medications which can help reduce the symptoms include antacids (which help to neutralize the effects of the acid), H2 Blockers (such as famotidine, ranitidine and cimetidine which help to reduce the acid secretion by the stomach), and proton pump inhibitors (which helps to reduce the acid production as well as help the damaged mucosa to recover).
However, if the symptoms of reflux fail to reduce by medications, surgical repair of the abnormal diaphragm wall may be required. The opening of the diaphragm (known as ‘hiatus’) is made smaller by incising the muscles of the stomach and lowering them. An incision can also be placed in the muscles of the chest wall. The procedure is usually done under general anesthesia. A tube is sometimes utilized to help position the stomach in relation to the hiatus.
Some surgeons can also perform this surgery using a laparoscope (the healing, patient acceptability and outcome is usually better than open surgery). In about 95 % of all patients, the hiatus defect is corrected through surgery, and helps in the reduction of symptoms (especially the reflux) (Mayo, 2006, NY Presbyterian Hospital, 2007, Mishra, 2007 & UW Health, 2006).
References:
Lee, J. A. (2006), Hiatus Hernia Repair, Retrieved on October 9, 2007, from Mayo UW Health Web site: http://apps. uwhealth. org/health/adam/hie/1/002925. htmMayo Clinic (2006), Hiatus Hernia Introduction, Retrieved on October 9, 2007, from Mayo Clinic Web site: http://www. mayoclinic. com/health/hiatal-hernia/DS00099/DSECTION=7 Mishra, R. K. (2007), Frequently asked questions about laparoscopic repair of hiatal hernia , Retrieved on October 9, 2007, from Mayo laparoscopy Hospital Web site: http://www. laparoscopyhospital. com/hiatal. htm NY Presbyterian Hospital (2007), Hiatal Hernia, Retrieved on October 9, 2007, from Mayo UW Health Web site: http://www. nyp. org/health/hiatal-hernia. html