Hiatal hernia

What is a hiatal hernia?

Hiatal hernia is an abnormality that occurs when the upper part of the stomach goes into the chest through a hole in the diaphragm (muscle that separates the abdomen from the thorax and is essential for breathing) called esophageal hiatus. Normally only the esophagus passes through the hiatus. Thus, when the stomach moves upwards, it means that the barrier function of the diaphragmatic hiatus is not effective and the contents of the stomach can easily pass into the esophagus.

Therefore, the existence of a hiatal hernia favors the, but is not its only cause. Although it is more common after the age of 50, there are many otherwise healthy people of all ages who develop a hiatal hernia.

Types

There are, mainly, two types of hernias hiatus:

• Sliding hiatal hernias or type I. They are the most frequent (90% of cases). In these cases there is a displacement of the junction area of ​​the esophagus with the stomach through the hiatus towards the thorax, for which the hernias enter and leave with changes in intrathoracic and intra-abdominal pressure.
• Paraesophageal or type II hernia. They are hernias that remain fixed in the chest.
• Mixed, has both components.

How is it produced?

The causes of these hernias are not known, although it is believed that they could be due to weakening of tissues or alterations in the development of the diaphragm. A series of risk factors for its development are described, such as:

• Age (over 50 years).
• .
• smoking
• Pregnancy.
• Increased intra-abdominal pressure (cough, constipation).

Symptoms

In many patients, the hiatal hernia can be asymptomatic. Although the sliding hernia when it presents symptoms is usually due to being associated with the presence of gastroesophageal reflux. Gastroesophageal reflux occurs when the lower esophageal sphincter has decreased muscle tone or opens improperly allowing stomach acid to pass into the esophagus. The characteristic symptom of reflux is heartburn or burningIt is a burning sensation that rises from the stomach to the throat.

Other symptoms that may appear include:

• Retrosternal pain (in the center of the chest).
• Belching and regurgitation (sensation of passage of the stomach contents), generally sour taste, to the mouth, in the absence of nausea and without effort. It occurs more frequently at night, favored by the decubitus position.
• Paraesophageal hernias are generally asymptomatic. If they reach a large size, they can produce chest pain or feeling short of breath (dyspnoea).
• The main complication of hernia is that it can become trapped and strangled, causing an urgent medical situation that requires urgent surgical treatment.
• The stinging or burning ("heartburn" in medical terms) that rises from the stomach to the throat, is the main symptom of GER. It is possible that it is associated with the passage of acidic or bitter foods from the stomach to the mouth. It generally worsens after meals, especially with foods that promote sphincter relaxation or dietary excesses. In many cases it also worsens during night rest or when the trunk is flexed. In some cases, the predominant symptoms are respiratory: hoarseness or hoarseness (due to irritation of the larynx due to refluxing acid) or even asthma or respiratory distress (due to aspiration of the acid into the respiratory tract).

Diagnosis

In addition to the symptoms for diagnose or prove the existence of a hiatal hernia We must resort to performing some techniques, especially if it is associated with the presence of gastroesophageal reflux:

• Esophagogastroduodenal transit: X-rays are taken after taking a pap of a barium contrast.
• . Allows direct view of the esophagus and stomach.
• Phmetrics. Test in which a measurement is made of the pH or the amount of acid that passes from the stomach to the esophagus during 24 hours. It allows you to see when the episodes occur, the number and their duration.
• Esophageal manometry: measures the pressure of the lower esophageal sphincter.

Treatment

The Asymptomatic hiatal hernia does not require treatment. Most are incidental findings on radiological examination or are diagnosed in the course of other examinations of the abdomen. This is indicated when there are the referred symptoms, especially gastroesophageal reflux and / or when complications appear. It can be necessary medical or surgical treatment.

It is advisable to follow a series of hygienic-dietary measures to improve symptoms such as: avoiding very large meals, not lying down or bending over right after a meal, quitting smoking and reducing weight. It is also advisable to eat fractional and small meals throughout the day that include easily digestible and non-irritating foods; Also avoid alcohol, coffee and citrus fruits.

Medical treatment to relieve symptoms due to reflux is done using drugs that neutralize acid secretion (antisecretors, antacids) and prokinetics (drugs that improve gastrointestinal motility).

The surgical treatment is indicated in patients with large hernias, which cause discomfort and discomfort, in some cases it is done preventively to prevent the hernia from strangling. Surgical treatment may also be necessary when there is gastroesophageal reflux that is not controlled with drugs, when it causes lesions in the esophagus or when medical treatment must be chronic.

Prevention

Control of risk factors such as overweight and tobacco and following dietary recommendations such as those described can help prevent symptoms.

Intensive Medicine Specialist