Hiatal hernia – symptoms, causes and other risk factors

This condition is happening when part of your stomach pushes upward through your diaphragm. We know that our diaphragm has a small opening known as hiatus through which esophagus (food tube) passes on its way to connect to your stomach. Our stomach can push up through this opening and it can cause a hiatal hernia. In the most cases, when people have a small hiatal hernia, then it does not cause problems and many people do not know that they have it until their doctor discovers it when he or she is checking for another condition. But if you have a large hiatal hernia, then this can allow food and acid to back up into your esophagus, which will lead to heartburn. [1] Medications or self – care measures can give a relief from the symptoms of this condition, but if you have a very large hiatal hernia, then this in some cases may need surgery. Diaphragm is a large muscle which lies between the chest and abdomen. We use the diaphragm to breathe. In normal people, the stomach is below the diaphragm but people who have hiatal hernia, a portion of their stomach pushes up through the muscle. It is known fact that hiatal hernia is most commonly happening in people who are over 50 years old. There was one study in which is said that hiatal hernia is affecting up to 60% of people by the time they are 60 years old [2].

Symptoms of hiatal hernia

In the most cases, when people have small hiatal hernia, then they do not cause signs or symptoms. But when people have large hiatal hernia, then they can cause signs and symptoms such as

• Vomiting blood or passing back stools, which may have indicate gastrointestinal bleeding
• Feeling especially full after meals
• Chest or abdominal pain
• Difficulty swallowing
• Belching
• Heartburn that gets worse when you lean over or lie down

If you have any persistent signs or symptoms that worry you, then you should talk with your doctor. If you cannot pas gas or empty your bowels, then visit your doctor. Also you should talk with your doctor if you have been vomiting or if you feel nauseated. You should not assume that hiatal hernia is causing your chest discomfort or pain. This could be a sign of peptic ulcers or heart problems.

Hiatal hernia causes

This condition is happening when weakened muscle tissue allows the stomach to bulge up through the diaphragm. It is not always clear why this condition is happening but age – related changes in the diaphragm and pressure on the stomach can contribute to the formation of hiatal hernia. We know that diaphragm is a large and dome – shaped muscle which can separate the chest cavity from the abdomen. In normal cases, the esophagus passes into the stomach through an opening in the diaphragm known as hiatus. When the muscle tissue surrounding the opening becomes weak and the upper part of the stomach bulges up through the diaphragm into the chest cavity, then hiatal hernia is occurring. Hiatal hernia can be caused by:

• Intense and persistent pressure on your surrounding muscles, such as when you are vomiting, coughing or straining during a bowel movement or while you are lifting heavy objects [3]
• Being born with an unusually large hiatus
• Injury to the area

Risk factors: This condition is most common in people who are:

• Obese [4]
• Age 50 or older [2]

Types of hiatal hernia: There are 2 general types of hiatal hernia and they are known as sliding hiatal hernia and fixed (or paraesophageal) hernias.

• Sliding hiatal hernia: The most common type of hiatal hernia is sliding hiatal hernia. It is happening when the stomach and esophagus slide into and out of your chest throughout the hiatus. This type of hernia tends to be small. Slide hiatal hernia usually does not cause any symptoms. They may not need treatment. [5]
• Fixed hiatal hernia: This is not a common type of hiatal hernia. This type of hiatal hernia is also known as paraesophageal hernia. In this type of hernia, part of your stomach pushes through your diaphragm and it stays there. Most cases of fixed hiatal hernia are not serious. But there is a risk that the blood flow to your stomach could become blocked. If this happens, then it can cause a serious damage and it will considered as a medical emergency.

References:

[1] Carrott P, DeBakey ME. Five facts you should know about hiatal hernias. Baylor College of Medicine. 2019. Retrieved from blogs.bcm.edu/2019/07/23/five-facts-you-should-know-about-hiatal-hernias/

[2] Wo J. Treatment of older patients with hiatal hernia. Gastroenterology and Hepatology. 2008;4(2):97-8.

[3] Nativ-Zeltzer N, Rameau A, Kuhn MA, et al. The relationship between hiatal hernia and cricopharyngeus muscle dysfunction. Dysphagia. 2019;34:391–6.

[4] Emerenziani S, Rescio MP, Guarino MPL, Cicala M. Gastro-esophageal reflux disease and obesity, where is the link? World Journal of Gastroenterology. 2013;19(39):6536–9.

[5] Pandolfino JE. Hiatal hernia and the treatment of acid-related disorders. Gastroenterology & Hepatology. 2007;3(2):92–4.