Understanding Hiatal Hernia

The diaphragm is a muscle that separates the chest from the abdomen. It has a small opening, called the hiatus, through which the esophagus passes before connecting to the stomach. A hiatal hernia occurs when part of the stomach bulges through this opening into the chest.

Types of Hiatal Hernias

1. Sliding Hiatal Hernia (Most Common Type)

• The stomach and lower esophagus slide up into the chest temporarily.
  
  
• Symptoms occur mostly when lying down or after eating.
  
  
• Often associated with GERD (Gastroesophageal Reflux Disease).
  
  

2. Paraesophageal Hiatal Hernia (Less Common but Serious)

• Part of the stomach pushes through the diaphragm but does not return to its normal position.
  
  
• Can lead to serious complications like strangulation (cutting off blood supply).
  
  
• Often requires surgical intervention.
  
  

What Causes a Hiatal Hernia?

Hiatal hernias develop due to increased pressure on the abdomen and weakening of the diaphragm muscles.

Common Causes Include:

• Chronic coughing or straining during bowel movements
  
  
• Obesity (increased pressure on the abdomen)
  
  
• Aging (diaphragm muscles weaken over time)
  
  
• Heavy lifting or physical exertion
  
  
• Pregnancy (hormonal changes and abdominal pressure)
  
  
• Previous abdominal surgery or trauma
  
  

Who Is at Risk?

Certain individuals have a higher risk of developing a hiatal hernia, including:

• People over 50 years old (muscle weakness increases with age)
  
  
• Obese individuals (excess weight increases pressure on the stomach)
  
  
• Chronic smokers (coughing weakens the diaphragm)
  
  
• Patients with acid reflux (GERD) (weakened esophageal muscles)
  
  
• Individuals with a family history of hiatal hernias
  
  

Symptoms of a Hiatal Hernia

Mild hiatal hernias may not cause noticeable symptoms. However, larger hernias can lead to:

• Frequent heartburn and acid reflux
  
  
• Chest pain or burning sensation
  
  
• Difficulty swallowing (dysphagia)
  
  
• Chronic cough or sore throat
  
  
• Regurgitation of food or sour liquid
  
  
• Shortness of breath (in severe cases)
  
  

If a paraesophageal hernia becomes strangulated, it can lead to:

• Severe chest or abdominal pain
  
  
• Vomiting or inability to eat
  
  
• Internal bleeding (black stools or vomiting blood)
  
  

A strangulated hiatal hernia is a medical emergency and requires immediate surgery.

Complications of an Untreated Hiatal Hernia

If left untreated, a hiatal hernia can lead to:

• Chronic GERD (acid reflux disease), increasing the risk of esophageal damage
  
  
• Esophagitis (inflammation of the esophagus)
  
  
• Esophageal ulcers and bleeding
  
  
• Barrett’s Esophagus, a precancerous condition due to long-term acid exposure
  
  
• Aspiration pneumonia, caused by stomach contents entering the lungs
  
  
• Strangulated hernia, cutting off blood supply to the stomach
  
  

Diagnosis of Hiatal Hernia

A hiatal hernia is diagnosed through:

• Upper Endoscopy (EGD): A thin tube with a camera examines the esophagus and stomach.
  
  
• Barium Swallow X-ray: The patient drinks a contrast liquid to highlight the hernia on X-rays.
  
  
• Esophageal Manometry: Measures pressure and function of the esophagus and lower sphincter.
  
  

Treatment Options for Hiatal Hernia

1. Lifestyle Modifications (For Mild Cases)

• Eat small, frequent meals instead of large portions.
  
  
• Avoid spicy, acidic, and fatty foods that trigger reflux.
  
  
• Maintain a healthy weight to reduce abdominal pressure.
  
  
• Elevate the head of your bed while sleeping to prevent reflux.
  
  
• Quit smoking and alcohol consumption.
  
  
• Avoid lying down immediately after eating.
  
  

2. Medications for Symptom Management

• Antacids (neutralize stomach acid)
  
  
• Proton Pump Inhibitors (PPIs) (reduce acid production)
  
  
• H2 Blockers (lower stomach acid levels)
  
  
• Prokinetics (improve esophageal motility)
  
  

These medications help control acid reflux symptoms, but do not treat the hernia itself.

3. Laparoscopic Hiatal Hernia Surgery (For Severe Cases)

When symptoms persist despite medication or if the hernia is large, surgery is the best option.

Laparoscopic Nissen Fundoplication is the gold standard for hiatal hernia repair.

• Minimally invasive (small incisions, faster recovery)
  
  
• The upper stomach is wrapped around the esophagus to prevent acid reflux.
  
  
• The hiatus opening is reinforced to prevent future hernias.
  
  

4. Open Surgery (For Large or Strangulated Hernias)

In rare cases, an open surgical approach may be necessary, especially if:

• The hernia is too large to be repaired laparoscopically.
  
  
• The stomach is strangulated, cutting off blood supply.
  
  

Hiatal Hernia Surgery Recovery and Aftercare

• Most patients can go home the next day after laparoscopic surgery.
  
  
• Mild discomfort is common but managed with medications.
  
  
• Soft diet is recommended for a few weeks to allow healing.
  
  
• Avoid heavy lifting and strenuous activity for at least 4–6 weeks.
  
  
• Reflux symptoms improve significantly after surgery, leading to better quality of life.
  
  

Get expert hiatal hernia treatment in Agra with

Dr. Shwetank Prakash, a specialist in minimally invasive laparoscopic surgery.

Fast relief from acid reflux, heartburn, and chest pain.

Book a consultation today!