Hiatal hernia

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Overview

A hiatal hernia is a medical condition in which the upper part of the stomach or other internal organ bulges through an opening in the diaphragm. The diaphragm is a muscular structure that assists in respiration and has a small opening, a hiatus, through which the esophagus passes prior to connecting to the stomach. This is called the gastroesophageal junction (GEJ). In a hiatal hernia, the stomach pushes through that opening and into the chest and compromises the lower esophageal sphincter (LES). This laxity of the LES can allow gastric content and acid to back up into the esophagus and is the leading cause of gastroesophageal reflux disease (GERD). While small hiatal hernias are often asymptomatic and can typically be managed medically, large hiatal hernias often requires surgery.


Classification of hiatal hernias are divided into 4 types:


Type I (sliding type), which represents more than 95% of hiatal hernias, occurs when the GEJ is displaced upwards towards the hiatus.

Type II is a paraesophageal hiatal hernia, which occurs when part of the stomach migrates into the mediastinum parallel to the esophagus.

Type III is both a paraesophageal hernia and a sliding hernia, where both the GEJ and a portion of the stomach have migrated into the mediastinum.

Type IV is when the stomach, as well as an additional organ such as the colon, small intestine, or spleen, also herniate into the chest.

Symptoms

Heartburn.

Regurgitation of food or liquids into the mouth.

Backflow of stomach acid into the esophagus (acid reflux)

Difficulty swallowing.

Chest or abdominal pain.

Feeling full soon after you eat.

Shortness of breath.

Vomiting of blood or passing of black stools, which may indicate gastrointestinal bleeding.

Causes

Doctors don’t know why most hiatal hernias happen. Causes might include:


Being born with a larger hiatal opening than usual

Injury to the area

Changes in your diaphragm as you age

A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet


Risk factors

A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people age 50 and older. Hiatal hernia occurs more often in overweight people and smokers.

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Complications

Severe GERD (gastroesophageal reflux disease)

Lung problems or pneumonia because stomach contents have moved up into your esophagus and into one or both lungs.

Strangulation of the hernia, cutting off blood flow to your stomach (medical emergency)

Prevention

losing weight (if needed)

decreasing food portion sizes.

eating several smaller meals throughout the day (as opposed to a few large meals)

elevating the head of your bed by 8 inches.

avoiding meals 2 to 3 hours before bedtime or before lying down.