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Hiatal Hernia - How Is it Diagnosed?

Written and reviewed by
MS - General Surgery, MBBS Bachelor of Medicine and Bachelor of Surgery
General Surgeon, Bangalore  •  20 years experience
Hiatal Hernia - How Is it Diagnosed?

What do we mean by a hiatal hernia?

The hiatus is an opening in the diaphragm (the muscular wall) which separates the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia, the stomach bulges up into the chest through that opening.

What does statistical data say about a hiatal hernia?

Statistically, approximately 60% of individuals who are above age 50 or older have a hiatal hernia.

In which age group is hiatal hernia very common?

The incidence of hiatal hernias increases with age. It is commonly seen in the older age people specifically in people who are above 50.

What are the causes of hiatal hernia?

The most common risk factors are as follows:

  1. Obesity Congenital deformities, such as scoliosis
  2. Certain types of surgery
  3. Major trauma
  4. Conditions which causes an increase in abdominal pressure within the abdomen, such as heavy lifting, or bending over, frequent or violent coughing, violent sneezing, violent vomiting, and straining during bowel movements

What are the types of a hiatal hernia?

There are four types of a hiatal hernia and they are as follows:

  1. Sliding hiatal hernia: This is the most common variant of a hiatal hernia. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus. It is usually asymptomatic.
  2. Fixed hiatal hernia: It is also known as a paraesophageal hernia. In a fixed hernia, part of the stomach pushes through diaphragm and stays there.
  3. Type III hiatal hernia: In this type, as a hernia goes on increasing, the phrenoesophageal ligament stretches and displaces the gastroesophageal junction above the diaphragm
  4. Type IV hiatal hernia: Type IV hiatal hernia includes a large defect in the phrenoesophageal ligament causing other organs, such as colon, spleen, pancreas and small intestine to enter the hernia sac.

What are the sign and symptoms of hiatal hernia?

Common symptoms include:

  1. Heartburn
  2. Chest pain or epigastric pain, coughing
  3. Difficulty in swallowing
  4. Belching, eructation, and hiccups

How to diagnose the condition?

To diagnose this condition following tests or procedures are included:

  1. X-ray of the chest and abdomen Barium follow-through examination of gastrointestinal tract (GI) to visualize GI tract.
  2. Upper endoscopy for examining the esophagus and stomach from inside Esophageal manometry for measuring the rhythmic muscular contractions of esophagus while swallowing, and also, measuring the force exerted by the muscles of esophagus.

What is the treatment available for it?

It includes medications and surgery which are as follows:

  1. Antacids to neutralize stomach acid and to reduce acid production
  2. Medications that heal the esophagus
  3. Surgery of opening of diaphragm to make it smaller and for reconstruction of an esophageal sphincter
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