hernia or hiatal hernia is
the protrusion (or herniation) of
the upper part of the stomach into
the thorax through a tear or weakness
in the diaphragm.
The symptoms include acid reflux, pains,
similar to heartburn, in the chest and upper
stomach. In most patients, hiatus hernias
cause no symptoms. Sometimes patients experience
heartburn and regurgitation, when stomach
acid refluxes back into the esophagus.
following are possible causes or contributing
factors for having an hiatal hernia:
Straining with constipation
Frequent bending over or heavy lifting
The diagnosis of a hiatus hernia is typically
made through an upper gastrointestinal barium
x-ray or by gastroscopy.
are two kinds of Hiatal Hernia:
first (95%) is the sliding hiatal hernia,
where the gastroesophageal junction moves
above the diaphragm together with some
of the stomach.
The second kind is rolling (or paraesophageal)
hiatal hernia, when a part of the stomach
herniates through the hiatus beside, and
without movement of, the gastroesophageal
most cases, sufferers experience no discomfort
and no treatment is required.Symptomatic
patients should be told to elevate the head
of their beds and avoid lying down directly
after meals. If overweight, weight loss
is indicated. Medications that lower the
LES pressure should be avoided. Antisecretory
drugs like proton pump inhibitors and H2-receptor
blockers can be used to reduce acid secretion.
Endoscopic plication or radiofrequency energy
delivery to the LES may be considered. Surgery
should be considered if these modalities
don't work. Surgery usually consists of
Nissen fundoplication, which usually is
successful in eradicating symptoms.
severe and chronic acid reflux is involved,
surgery is sometimes recommended, as chronic
reflux can severely injure the esophagus.
Persons requiring surgery might experience
heartburn or might not perceive any symptoms.
Nissen fundoplication is performed laparoscopically;
however, this can have both severe and minor
side-effects. Minor side-effects of this
procedure include increased production of
stomach and intestinal gas, and chronic
nausea; major ones include permanent severe
discomfort when eating and passing food
into the stomach, inability to vomit or
belch normally, and limited stomach capacity.
depend greatly on individual anatomy and
surgical technique, but due to the severe
degree of potential discomfort in some cases,
surgery is only recommended as a last resort
if medication therapy is ineffective or
impractical. Traditionally, surgery was
recommended as a primary solution, but a
statistical increase in complications and
severe discomfort levels among patients,
resulting from the high volume of procedures
performed, has led to a radical change of
practice and attitiude. Another method for
treating this condition is chiropractic
care. Chiropractic adjustments at the T5-T6
spinal nerve root levels have been found
to help minimize the effects of this pathology.
A hiatus hernia per se does not cause any
symptoms. The condition promotes reflux
of gastric contents (via its direct and
indirect actions on the anti-reflux mechanism)
and thus is associated with gastro-esophageal
reflux disease (GERD). In this way a hiatus
hernia is associated with all the potential
consequences of GERD- heartburn, esophagitis,
Barretts oesophagus and oesophageal cancer.
However the risk attributable to the hiatus
hernia is difficult to quantify, and at
most is low.
discomfort from reflux and dysphagia, hiatal
hernias can have severe consequences for
patients if not treated. While sliding hernias
are primarily associated with gastroesophageal
acid reflux, rolling hernias can strangulate
a portion of the stomach above the diaphragm.
This strangulation can result in esophageal
or GI tract obstruction and even become
ischemic and necrose. Another severe complication,
although very rare, is a large herniation
that can restrict the inflation of a lung,
causing pain, breathing problems.
Hiatal hernias affect anywhere from 1 to
20% of the population.
Of these, 9% are symptomatic, depending
on the competence of the lower esophageal
sphincter. 95% of these are "sliding"
hiatal hernias, in which the lower esophageal
sphincter (LES) protrudes above the diaphragm
along with the stomach, and only 5% are
the "rolling" type (paraesophageal),
in which the LES remains stationary but
the stomach protrudes above the diaphragm.
People of all ages can get this condition,
but it is more common in older people.
to "Gastric Enterology Surgery"