In a hiatus hernia, part of the stomach slips up through the hole in the diaphragm where the oesophagus passes from the chest to the abdomen.
A hiatus hernia may be caused by increased pressure in the abdominal cavity from heavy lifting, obesity, and emotional tension (muscle spasm occurs), or slack ligaments in the diaphragm in the elderly.
There are two types of hiatus hernia:-
- Paraoesophageal hiatus hernias occur when a pocket of stomach slips up through the hole in the diaphragm beside the oesophagus. Most are small, but sometimes a large proportion of the stomach may push up into the chest.
- Sliding hiatus hernias (90% of hiatus hernias) result from the stomach sliding up into the chest, pushing the oesophagus further up into the chest.
Patients usually describe heartburn (usually worse at night when lying down, or after a meal), excessive burping, a bitter taste on the back of the tongue (waterbrash), difficulty in swallowing and sometimes pain from ulceration inside the hernia or pinching of the hernia. Further symptoms may include a feeling of fullness, and palpitations if a large hernia pushes onto the heart. Bleeding may occur from ulcers that form in the damaged part of the stomach.
A barium swallow x-ray or gastroscopy (passing a tube through the mouth into the stomach) is used to confirm the diagnosis.
Paraoesophageal hiatus hernias should be surgically repaired, often in a procedure known as fundoplication, unless the patient is elderly or in poor health, while sliding hiatus hernia can usually be treated with medications (eg. proton pump inhibitors) that reduce the amount of acid secreted by the stomach or increase the emptying rate of the stomach (eg. domperidone) and strengthen the valve at the lower end of the oesophagus, posture and diet.
Frequent small meals, rather than three large meals a day, and a diet low in fat and high in protein is beneficial. Obese patients must lose weight.
Medications are usually very successful in controlling symptoms, and the results of surgery are generally good.