Diaphragmatic Hernia – Timely Intervention for Better Health

A diaphragmatic hernia occurs when the upper part of the stomach is pushed through a weak spot in the diaphragm into the chest cavity. This condition is especially common in middle age and may sometimes be asymptomatic; however, when symptoms do appear, they are usually manifested as heartburn and acid reflux.
Why is it important to treat a diaphragmatic hernia promptly?

• Prevention of Immediate Complications: early treatment prevents intestinal obstructions or strangulation, which could lead to emergency surgery.
• Prevention of Associated and Long-Term Complications: early intervention reduces the risk of complications such as bleeding at the esophagogastric junction, asthma, chronic cough, aspiration, persistent reflux, and dysphagia (difficulty swallowing).

Classification of Diaphragmatic Hernia:

• Type I (Sliding Hernia): the upper part of the esophagus that connects to the stomach slides upward into the chest through an enlarged opening, then “slides” back into the abdominal cavity.
• Types II–IV (Paraesophageal Hernias):
• Type II: partial protrusion of the upper part of the stomach through the opening near the esophagus.
• Type III: a combination, where part of the esophagus and part of the stomach pass through the opening.
• Type IV: a rare case in which additional organs, such as intestines or the omentum, also protrude through the opening.

Diagnosis and Treatment of Diaphragmatic Hernia:
Diagnosis is usually made when symptoms such as heartburn or pain in the chest and upper abdomen prompt further investigation. Diagnostic methods include:

• Barium Swallow (Esophagography): A test using contrast material and X-rays to visualize the esophagus, stomach, and duodenum.
• Endoscopy: A procedure using a flexible tube with a camera inserted through the mouth to examine the internal surfaces of the esophagus and stomach.
• Esophageal Manometry: A test that measures the movements of the esophageal muscles during swallowing.

Treatment Options:

• Medical Treatment: Medications such as antacids, H2 blockers, and proton pump inhibitors help reduce acid production and alleviate symptoms.
• Surgical Intervention: In severe cases or when complications occur, a surgical procedure is performed to reduce the opening in the diaphragm and repair the lower esophageal muscles. Sometimes, diaphragmatic hernia repair is combined with bariatric surgery to improve symptoms alongside weight loss.

If you experience symptoms of a diaphragmatic hernia, it is essential to seek a surgical consultation promptly. Contact me to schedule a personal consultation, and together we will explore the treatment options best suited for you.