Content

Introduction

Introduction

A hiatal hernia consists of a part of the stomach moving up into the chest through an opening in the diaphragm.

The diaphragm is a dome-shaped muscle layer that separates the chest from the abdomen and contains an opening to allow the esophagus (a kind of tube through which ingested foods and liquids pass) located in the chest to reach the stomach. which, instead, is found in the abdomen. It is through this opening, calling diaphragmatic hiatus, that the stomach in cases of hiatus hernia protrudes into the chest. The word "hernia", in fact, means protrusion and the term "hiatus" opening.

The hiatal hernia can be of three types:

  • from slipping, the most common, in which the hernia enters and exits the chest cavity. It is not a permanent condition, as the affected portion of the stomach moves up and down, depending on the pressure exerted on the abdomen. It is more common in obese people
  • paraesophageal, where the upper part of the stomach (bottom) gets trapped in the chest cavity, next to the esophagus.
  • Mixed hernia, contemporary presence of sliding hernia and paraesophageal hernia, more rare

Hiatal hernia is a fairly common condition, especially in people over the age of fifty, overweight and pregnant women.

In Italy, about 15% of the population has a hiatal hernia, but the percentage rises in the age groups over fifty "years, up to almost all people over the age of eighty".

If the hiatal hernia does not cause any problems, it is usually not necessary to perform surgery or institute drug therapy.

Causes

Causes

The causes of hiatal hernia are not clear. It is assumed that in some cases the weakening, with consequent enlargement, of the diaphragm opening (diaphragmatic hiatus) is already present at birth, due to genetic components.

Among the various factors that can favor the appearance of a hiatal hernia, the most common are:

  • diaphragm changes, related to old age
  • abdominal trauma
  • aperture of the diaphragm (diaphragmatic hiatus) wider than normal, present from birth (congenital)
  • pressure, exerted by the contraction of the abdominal muscles, caused by coughing, vomiting, efforts during evacuation, lifting of weights
  • pregnancy, for the consequent increase in abdominal pressure
Symptoms

Symptoms

Many people have a "hiatal hernia, that is to say the ascent of a part of the stomach into the esophagus" without knowing it because they do not feel any disturbance.

When disturbances (symptoms) appear they are mostly associated with the possible presence of gastroesophageal reflux, that is to say from the passage of food or liquids contained in the stomach into the esophagus. They manifest themselves with:

  • heartburn, especially after meals
  • acid regurgitation
  • bad breath (halitosis)
  • frequent belching and bloating
  • nausea
  • difficulty or pain in swallowing (dysphagia)

It is advisable to consult your family doctor if the complaints persist for more than three weeks, if they get worse, if the over-the-counter drugs recommended by the pharmacist have no effect. In particular, it is necessary to request an urgent medical examination in case of:

  • slimming unintentional
  • worsening of difficulty in swallowing
  • frequent vomiting
  • traces of blood in the vomit
  • pain in the upper abdomen

Sometimes gastroesophageal reflux can be favored by a hiatal hernia, but the two conditions are not always associated.

In rare cases, in the case of paraesophageal hernia, there may be such an increase in the volume of the hernia as to create respiratory disturbances and the appearance of bleeding ulcerations in the stomach and anemia.

Diagnosis

Diagnosis

The assessment of the hiatal hernia is generally carried out through instrumental tests such as:

  • radiography with barium of the upper part of the digestive tract, allows you to evaluate the ability to swallow and the presence of any obstructions, or abnormalities, of the esophagus. It consists in drinking a solution of barium (a harmless substance but clearly visible on X-rays as it passes through the digestive system) and in being subjected, shortly after, to an x-ray
  • esophagus-gastro-duodenoscopy, endoscopic examination (method of exploration that allows to visualize the inside of the body through an optical tube equipped with micro cameras that transmit the images to a screen) that allows to examine the inside of the upper part of the digestive system through an endoscope, thin flexible tube with a light and a video camera at the end. The endoscope is inserted through the mouth and throat: the person is usually awake and / or subjected to light sedation. Endoscopic exploration allows to evaluate the state of the esophagus and stomach mucosa (erosions, ulcers ) and to find out any complications due to gastroesophageal reflux, if any
Therapy

Therapy

The cure (therapy) of the hiatal hernia consists first of all in the treatment of the disorders associated with it. It may be useful to consume small and frequent meals, as recommended also for the disorders deriving from gastroesophageal reflux.

It is advisable to stop smoking if you have this habit, as smoking can irritate the digestive system and worsen ailments.

It is also very important to maintain a healthy weight, lose weight, if you are overweight, and avoid certain foods including: coffee, chocolate, foods that are too fatty, hot or spicy.
It is also advised not to lie down immediately after meals.

For the treatment of disorders caused by hiatal hernia, after consulting with your doctor, you can take over-the-counter (or self-medication) drugs, sold without a prescription, such as antacids and / or alginates.

If changes in eating habits and the use of over-the-counter medications have no effect and the complaints persist, the doctor may prescribe the same drugs used for gastroesophageal reflux, such as proton pump inhibitors that reduce the acidity of gastric juices or antagonists. H2 receptors (H2 antagonists) used to block the action of histamine on stomach cells by decreasing the release of hydrochloric acid and therefore the acidity of gastric juices.

If the disturbances caused by the hiatal hernia are particularly intense and the drugs have no effect, surgery may be required which is usually performed through small holes in the abdomen (a technique called laparoscopy) and under general anesthesia. typically requires a two to three day hospital stay and three to six weeks of convalescence.

The disturbances do not disappear immediately after the operation: sometimes the feeling of swelling, bloating, belching and difficulty in swallowing persist for a few months.

In some cases (about 1 in 100) it is necessary to repeat the operation.

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