SURGEON
Hiatal Hernia: Types and Treatments
Introduction
A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm opening into the chest cavity. It’s a common condition, especially with age. It doesn’t always cause symptoms, but when they do occur, they are usually related to acid reflux.
Classification of Hiatal Hernias
Hiatal hernias are classified into four types:
Hiatal hernias are quite common, especially as people age. In the USA, they affect about 20% of the general population. The incidence increases with age: 50% after age 50, 60% after age 60, and 70% after age 70.
Diagnosis and Treatment of Hiatal Hernia
Diagnosis
A hiatal hernia is often discovered during tests or procedures aimed at identifying the cause of heartburn or chest or upper abdominal pain. These tests and procedures include:
Most people with a hiatal hernia do not experience symptoms and do not need treatment. If you have symptoms, such as frequent heartburn and acid reflux, you may require medication or surgical intervention.
Medications:
Surgical intervention can help those who do not respond to medications for heartburn and acid reflux. Surgery can also assist with complications such as severe esophageal inflammation. The operation involves reducing the hole in the diaphragm and reconstructing the muscles of the lower esophagus to prevent the return of stomach contents. Sometimes hiatal hernia surgery is combined with weight loss surgery, such as gastric sleeve resection or gastric bypass. Because of this association with gastroesophageal reflux symptoms, many now recommend looking for, and repairing hiatal hernias at the time of bariatric procedure.
A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm opening into the chest cavity. It’s a common condition, especially with age. It doesn’t always cause symptoms, but when they do occur, they are usually related to acid reflux.
Classification of Hiatal Hernias
Hiatal hernias are classified into four types:
- Sliding Hernia (Type I): The most common type, where the part of the esophagus that joins the stomach moves up through the enlarged opening and then “slides” back down.
- Paraesophageal Hernia (Types II-IV): The other three types are paraesophageal hernias. Type II is where the upper part of the stomach goes through the opening next to the esophagus, forming a hernia. Type III is a combination of the first two types, where part of the esophagus moves through the opening, and another part of the stomach also protrudes next to the esophagus. Type IV is a rare case where two different organs, such as the stomach, intestine, omentum, and other abdominal organs, can penetrate through the opening.
Hiatal hernias are quite common, especially as people age. In the USA, they affect about 20% of the general population. The incidence increases with age: 50% after age 50, 60% after age 60, and 70% after age 70.
Diagnosis and Treatment of Hiatal Hernia
Diagnosis
A hiatal hernia is often discovered during tests or procedures aimed at identifying the cause of heartburn or chest or upper abdominal pain. These tests and procedures include:
- Upper GI X-ray: After taking a contrast that coats the inner lining of the digestive tract, X-rays are taken to see the contours of the esophagus, stomach, and upper intestine.
- Endoscopy: A procedure that allows examination of the esophagus and stomach using a thin tube with a camera (endoscope). The endoscope is inserted through the mouth and allows checking the inner surface of the esophagus and stomach for inflammation.
- Esophageal Manometry: This test measures the rhythmic muscle contractions of the esophagus during swallowing. It also assesses the coordination and strength of the esophageal muscles.
Most people with a hiatal hernia do not experience symptoms and do not need treatment. If you have symptoms, such as frequent heartburn and acid reflux, you may require medication or surgical intervention.
Medications:
- Antacids that neutralize stomach acid.
- Medications to reduce acid production (H-2 receptor blockers).
- Medications that block acid production and promote healing of the esophagus (proton pump inhibitors).
Surgical intervention can help those who do not respond to medications for heartburn and acid reflux. Surgery can also assist with complications such as severe esophageal inflammation. The operation involves reducing the hole in the diaphragm and reconstructing the muscles of the lower esophagus to prevent the return of stomach contents. Sometimes hiatal hernia surgery is combined with weight loss surgery, such as gastric sleeve resection or gastric bypass. Because of this association with gastroesophageal reflux symptoms, many now recommend looking for, and repairing hiatal hernias at the time of bariatric procedure.