The hiatus hernia is the partial drift of the stomach through the diaphragmatic muscle isolating the abdomen from the thorax. The only symptoms are often chest pains and heartburn; in severe cases an operation is available but in moderate cases the condition can be deled with drugs.
The stomach usually goes up into the chest by the esophageal hole which is the weakest point between abdomen and chest cavity. There are two most common types of hiatus hernia: one occurs when the upper sphincter binding esophagus and stomach slides up through the diaphragm and the other when a part of the stomach gets into the chest beside the esophagus.
Risk factors for hiatus hernias are smoking, age over 50, obesity and pregnancy. The age weakens the diaphragm, coughing due to smoke and overweight increase the pressure inside the abdomen. Rarely a congenital hiatus hernia occurs when the diaphragm or the stomach have not developed correctly during the intra uterine life.
Refined hernial symptoms are burning sensations oa feeling of warmth both called heartburn and caused by the reflux of the acid gastric content into the esophagus. If symptoms persist and get worse in time, the condition is called gastroesophageal reflux disease. This hernia can also cause pain and discomfort behind the sternum and mime a heart attack.
Hiatus hernia symptoms usually get worse after eating, drinking coffee or hot drinks, and lying down or binding forward. Spicy foods will generate burnings as well. All these symptoms are more likely to be caused by indigestion so certain diagnose of hiatus hernia can only be established after several testing.
Occasionally, hiatus hernias can lead to severe complication due to the acid reflux into the lower part of the esophagus. Acid damages can produce an ulceration of the esophageal layers in time and pain, burning sensations will worsen. Bleeding ulcers can cause patients to vomit blood. Immediate medical consult is required to stop the bleeding. Bleeding ulcers also lead to anemia and the body is in lack of sufficient red blood cells to support a healthy oxygenation.
When healing, esophageal ulcers can cause strictures; this will lead to regurgitation and difficult, painful swallowing.
The hiatus hernia increases the risk of Barrett esophagus, a pre-malign stage when the outer layer cells change their anatomy and function. Persons with gastroesophageal reflux are more likely to develop esophageal cancer.
All patients with indigestion symptoms must be seen by a gastroenterologist and undergo a barium X-ray that can detect a hiatus hernia and an endoscopy with a long telescope introduced into the abdomen.