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Hiatal Hernia

What is a hiatal hernia?

A hiatal hernia is a condition that causes part of your stomach to bulge through a hiatus (hole) in your diaphragm. The part of the stomach may move up and down, or it may get trapped above the diaphragm.

What increases my risk for a hiatal hernia?

The exact cause of a hiatal hernia is not known. You may have been born with a large hiatus in the diaphragm. The following are possible conditions that may increase your risk of a hiatal hernia:

  • A family member with a hiatal hernia

  • Increased pressure inside the abdomen, such as if you are overweight or pregnant

  • Shortening of the esophagus due to swelling and scarring

What are the types of hiatal hernia?

  • Type I (sliding hiatal hernia): A portion of the stomach slides in and out of the hiatus. This type is the most common and usually causes gastroesophageal reflux disease (GERD). GERD occurs when the lower muscle of the esophagus does not close properly and causes acid reflux.

  • Type II (paraesophageal hiatal hernia): Type II hiatal hernia forms when a part of the stomach squeezes through the hiatus and lies next to the esophagus.

  • Type III (combined): Type III hiatal hernia is a combination of a sliding and a paraesophageal hiatal hernia.

  • Type IV (complex paraesophageal hiatal hernia): The whole stomach, the small and large bowels, spleen, pancreas, or liver is pushed up into the chest.

What are the signs and symptoms of a hiatal hernia?

Heartburn is the most common symptom of a hiatal hernia. This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may also have one or more of the following signs and symptoms:

  • Abdominal pain, especially in the area just above your navel

  • Bitter or acid taste in your mouth

  • Choking, coughing, or shortness of breath

  • Trouble swallowing

  • Frequent burping or hiccups

  • Blood in your vomit, or black bowel movements

  • Weight loss

How is a hiatal hernia diagnosed?

  • Barium swallow: This test is an x-ray of your throat and esophagus, the tube connecting your throat to your stomach. This test may also be called a barium esophagram. You will drink a thick liquid called barium. Barium helps your esophagus and stomach show up better on x-rays. Follow the instructions of your caregiver before and after the test.

  • Endoscopy: This test uses a scope to see the inside of your digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests. Small tumors may be removed, and bleeding may be treated during an endoscopy.

How is a hiatal hernia treated?

Your healthcare provider may suggest that you make diet and lifestyle changes. You may also need any of the following:

  • Medicines: Medicines may be given to relieve the symptoms caused by a hiatal hernia, such as acid reflux. These may include antacids and medicines for vomiting, frequent burping, and hiccups.

  • Surgery: Surgery may be done when medicines cannot control your symptoms or other problems are present. Your caregiver may also suggest surgery depending on the type of hernia you have. Your healthcare provider can put your stomach back into its normal location or make the hiatus (hole) smaller and anchor your stomach in your abdomen. Fundoplication is a surgery that wraps the upper part of the stomach around the esophageal sphincter to strengthen it. A sphincter is a ringlike muscle that opens and closes an opening in your body.

What are the risks of a hiatal hernia?

  • Your esophagus, stomach, blood vessels, or nerves may get injured during surgery. You could also have trouble breathing, get infected, or have a lot of bleeding after surgery. You may also feel bloated after meals. Even after surgery, you may get another hiatal hernia.

  • If a hiatal hernia is not treated, you may develop gastroesophageal reflux disease (GERD). This may lead to ulcers and bleeding in the esophagus. The hiatal hernia may also slide into your chest, get trapped, and not slide back into your abdomen. The trapped stomach may die if its blood supply is cut off. You may also have sudden severe chest pains and problems swallowing. This may lead to other serious medical problems.

When should I contact my healthcare provider?

Contact your healthcare provider if:

  • Your symptoms are getting worse.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You feel very full and cannot burp or vomit.

  • You have severe chest pain and trouble breathing all of a sudden.

  • Your bowel movements are black or bloody.

  • Your vomit looks like coffee grounds or has blood in it.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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