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Hiatus Hernia – Symptoms, Causes, Diagnosing, Treatment

A hiatus hernia is a condition developed when the upper part of the stomach bulges through an opening in the diaphragm. The diaphragm is a muscle that separates the abdomen and chest. It has a small opening through which the food tube passes and connecting to the stomach. In a hiatus hernia, the stomach pushes up through the opening in the diaphragm and bulges into the chest. The bulging of stomach to the chest can cause food and acid going up into the esophagus causing heartburn.

Symptoms of hiatus hernia

Heartburn
Backflow of food and liquids into the mouth
Backflow of stomach acid into the esophagus
Difficulty in swallowing
Chest or abdominal pain
Shortness of breath

Causes

A hiatus hernia may be caused by:

Age-related changes in the muscles of the diaphragm
Injury to the area after trauma or surgery
Birth defects with an unusually large hiatus
Persistent and intense pressure on the surrounding muscles of the diaphragm
Obesity

Diagnosing Hiatus Hernia

Endoscopic examination of the esophagus and the stomach will diagnose the condition. Other test includes x-ray with dye of the upper digestive system and esophageal manometry to measure the rhythmic muscle contractions and coordination and force exerted by the muscles of the esophagus when food is swallowed.

Treatments

Medications are prescribed to ease the symptoms including recurrent heartburn, acid refluxes and to reduce acid production. Medication along with lifestyle modification is necessary:

Consume several smaller meals rather than a few large meals
Avoid fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine that trigger heartburn
Avoid lying down right after a meal
Have the dinner at least two to three hours before bedtime.
Maintain a healthy weight or reduce the excess weight
Stop smoking and alcohol consumption
Elevate the head end of bed while lying
Perform any kind of physical activity or exercises at least 5 days a week

Options include pulling back the bulged stomach into the abdomen and reconstructing an esophageal sphincter.

Open Method: Less preferred due to difficulty to perform and severe pain the patient will experience later.

Laparoscopic Repair of Hiatus Hernia

It is the gold standard treatment for hiatus hernia with excellent result as the cuts are very small and handling of intestines is very minimal. If required 3 days of hospitalization and the procedure is done under general anesthesia. Short period of reduced activity is recommended – maybe for 10 days.

The patient can have soft diet initially and then normal diet in 2 weeks’ time. The patient may have to continue antacid drugs for a month or so.

Hiatus Hernia – Stomach View

Hiatus Hernia – Wide Hiatus

Esophagus with Vagus Nerve – seen on monitor through laparoscope on repair of Hiatal Hernia

Hiatus Hernia Repair – Hiatus Opening Closed

Fundoplication – Stomach wrap around Esophagus

Keyhole Clinic, Metro Pillar No. 448, Edappally, Kochi, Kerala

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