Hiatus hernia
The diaphragm has a small opening called an ‘oesophageal hiatus’. A hiatus hernia is when the upper section of the stomach bulges through the diaphragm (a large, thin sheet of muscle between the chest and the abdomen) and goes up into the chest area.
It’s relatively common in people over 50. If it’s not causing you problems, it does not normally need treatment. However, a hiatus hernia can make you prone to having gastroesophageal reflux disease (GORD) symptoms, so it is best to get checked by a specialist to diagnose your condition accurately.
Symptoms
Most small hernias won’t cause noticeable symptoms. However, large hiatus hernias can cause:
- Bad breath
- Burping
- Feeling bloated
- Acid reflux (heartburn)
- Feeling or being sick
- Trouble swallowing
- Chest or abdominal pain
- Shortness of breath
As a result of a hiatus hernia, you can develop GORD in addition to your condition. This is due to the hiatus hernia preventing the valve at the bottom of the oesophagus from working correctly.
We advise you to seek urgent medical attention if you are experiencing the following symptoms, as they may be signs of a serious medical condition:
- Passing of black stools
- Vomiting of blood
Causes
A hiatus hernia develops if there is a weak spot in your oesophageal hiatus and/or diaphragm, meaning there is an opening for the hernia to come through.
Several reasons, such as a congenital disability (birth defect), injury, age or surgery, can cause this weakness. Often, a weakness is caused by daily stress and strain. This daily pressure on the abdomen (tummy) can be caused by:
- Chronic coughing or sneezing
- Constipation
- Obesity (BMI, or body mass index, greater than 30)
- Intense exercise or heavy lifting
- Frequent vomiting
- Pregnancy and childbirth
Who is at risk?
Hiatus hernia can occur in anybody, but people are at higher risk if they are:
- over 50 years of age
- overweight
- pregnant
In the UK, it is estimated that a third of people over 50 have a hiatus hernia.
Risks
Complications as a result of a hiatus hernia are rare but can be serious.
Due to the risk of GORD, damage to the oesophagus can happen due to stomach acid travelling up into the gullet (oesophagus). This can lead to issues such as:
- Oesophageal ulcers
- Oesophageal strictures
- Barrett’s oesophagus
- Strangulated hernia
- Oesophageal cancer
Diagnosis
In your initial consultation, we will evaluate your medical and family history to determine whether you are at an increased risk of developing a hernia. We will also consider your symptoms and perform a physical examination to check for any signs of the condition.
We may then perform further tests if we detect or suspect anything abnormal. These may include:
Endoscopy (gastroscopy) – this involves passing a thin, flexible tube equipped with a light and video camera (endoscope) down the throat and into the oesophagus and stomach to check for any inflammation.
Barium swallow – this involves swallowing a solution of barium sulphate and taking an x-ray of the upper digestive tract to identify the location and positioning of the gastric organs.
Oesophageal manometry – this involves passing a thin, flexible tube called a catheter into the oesophagus via the nose and throat. The catheter contains pressure sensors that measure the muscular contractions of the oesophagus.
96-hour pH capsule (BRAVO or ALPHA) – these tests measure and record any stomach acid that travels up your oesophagus (food pipe) over 96 hours. They are far more comfortable and safer alternatives to the 24-hour pH impedance test.
Treatment
Once we have determined that you have a hiatus hernia, we will suggest treatment if your symptoms are causing issues.
Lifestyle changes
We may recommend making some lifestyle changes to help elevate symptoms.
Some lifestyle changes you can make include:
- Eating smaller, frequent meals instead of 3 large meals
- Avoid drinking at nighttime
- Avoiding certain foods and drinks that may trigger acid reflux
- Avoid stooping or bending, especially after eating
- Quit smoking
Medication
If you are experiencing acid reflux, we may suggest taking the following medication:
- Antiacids
- Alginates
- H2-receptor antagonist
- Proton-pump inhibitors (PPIs)
Surgery
If you are not responding to medication and lifestyle changes, we may recommend surgery. You may also want to consider surgery if you don’t want to take medication in the long term. However, having surgery is not a guarantee that you will not need medications in the future.
Keyhole surgery (laparoscopy) is usually administered. It involves making minor cuts in your abdomen under general anaesthetic. The procedure involves pushing the stomach down and making the opening in the diaphragm smaller. It may also include reshaping the muscles of the lower oesophagus.
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Book an appointment
It’s important to distinguish what your symptoms mean so we can accurately diagnose and treat the correct condition based on your needs.
Our expert gastroenterologists can help. Call us today at +44 (0) 207 4594918 to book a private consultation.