There is a muscle layer called the diaphragm that separates the abdominal cavity from the chest that includes the lungs and the heart. Under this muscle layer, the stomach located from the midline to the left. The esophagus, which provides the delivery of oral food to the stomach, is connected to the stomach by passing through an opening in the diaphragm. The deformation of the structures that make up this opening and the displacement of a part of the stomach from its original location through the chest cavity is called a hiatal hernia.

While small-sized hernias may not cause significant symptoms, large-sized hernias may cause serious symptoms such as heartburn, regurgitation, pain, dysphagia (difficulty in swallowing) bleeding, shortness of breath, nausea and vomiting.

Why Does a Hiatal Hernia Occur?

Congenitally wider esophageal hiatus, obesity, presence of factors that increase intra-abdominal pressure (chronic cough, lifting heavy objects, repetitive vomiting, straining), trauma and age-related changes in the diaphragm muscle are among the factors that may cause hiatal hernia. Particularly individuals over the age of 50 and those who are obese are at significant risk.

Diagnosis

The way to establish a diagnosis begins with the interpretation of the patient's symptoms and findings of physical examination. Additional examinations such as endoscopy and, if necessary, contrast-enhanced radiological studies and manometry are required. In the endoscopy, a thin tube with a camera and light at the end is inserted into the stomach via the mouth. The inside views of the esophagus and stomach are visualised. The presence of any herniation is investigated by recognizing the level of the extrinsic pressure of the diaphragmatic crura to the stomach wall. In contrast studies, the patient is asked to drink the contrast-enhanced liquid before X-ray. This liquid covers the inside of the esophagus and stomach, and the hernia is tried to be detected by determining the location of the esophagus and stomach.

Esophageal manometry is designed to determine any inaccuracy in the structure called the sphincter, located at the junction between the esophagus and the stomach, which prevents the escape of stomach contents back to the esophagus. If the stomach becomes herniated, this sphincter loses its function due to its structural incompetency.

Treatment

Small-sized hernias may not cause symptoms anda re generally monitored without treatment. Recurrent heartburn and acid reflux are critical symptoms, especially for initiation of treatment.

Medication

Antacids: Irritation of the esophagus as a result of exposure of the acidic content of the stomach back to the esophagus causes symptoms in the patient. Antacid drugs are used to reduce the acidity level of the gastric fluid in order to reduce the irritation in the esophagus and symptoms of the patient

Drugs that reduce acid production: These drugs reduce the acidity of the gastric fluid by inhibiting the mechanism of acid secretion in the acid-producing cells of the stomach. The decreased acid level reduces the irritation and inflammation of the esophagus

 

In general, treatments to reduce gastric acid have limited benefit due to diaphragmatic hernia.

 

Surgical treatment

Surgical treatment is required in cases where medical treatment is not sufficient or it is not possible to continue normal life due to severe anatomy deterioration. With surgical treatment, strictures and cancer formation in the esophagus that may occur after persistant irritation and inflammation may be prevented. In general terms, the operation consists of the steps of retracting the part herniated into the chest back into the abdominal cavity, removing the hernia sac, reducing the hole that keeps the connection between the esophagus and the stomach in the diaphragm and acting as a sphincter, reconstructing the sphincter and establishing an antireflux procedure . The operation is usually performed laparoscopically depending on the patient's condition, additional diseases, and the degree of the hernia.