The hiatal hernia is a condition in which a portion of the stomach extends through an opening of the diaphragm located in the thorax. The diaphragm is the muscular layer that separates the thorax from the abdomen; that is where there is an opening called a hiatus, which allows the esophagus to pass through and join with the stomach. A hiatal hernia occurs when the stomach protrudes through this opening.
The cause of this type of hernia is unknown. The hiatal hernia may be due to weakness of the supporting tissue. The risk of this problem increases with age, obesity and smoking or other tobacco use. Hiatal hernias are very common and can lead to disease mainly due to gastroesophageal reflux.
This condition can cause a reflux (regurgitation) of gastric acid from the stomach to the esophagus.
The main symptoms of hiatal hernia are gastroesophagal reflux, pain in the thorax caused by acid that comes up into the esophagus as well as eating quickly and excessively. Dysphagia, which is the pain from swallowing food or liquid.
It is the opening of the hiatus that mainly provokes gastroesophagal reflux. There is a valve or lower esophageal sphincter and, along with the diaphragm, they carry out their function and when the hiatus is open, the sphincter provoking the reflux stops functioning.
Gastric reflux is a main symptoms in addition to pain when consuming food or liquids and burping. A burning sensation from the stomach to the throat, frequent respiratory infections due to the acid going into the respiratory tracks. A feeling of pressure in the throat and difficulty in swallowing.
The main exam is called a gastric endoscopy in which the lower esophageal sphincter as well as the stomach are evaluated. Once we have a diagnostic of the hiatal hernia, if we consider that surgery is required for the hiatal hernia, esophageal manometry and pH esophageal metria exams must be conducted.
The treatment depends on the severity of the symptoms and the degree of the hiatal hernia. It can range from medical treatment to alleviate the symptoms to surgical treatment, which involves reinforcing the valve or lower esophageal sphincter and thus avoiding acid reflux into the esophagus. The most common surgical technique is called laparoscopic nissen fundoplication. In addition to changes in dietary habits, reducing the intake of alcohol, not smoking or consuming irritants as well as losing weight in case of obesity is essential.