Hernia, hiatus – 1

Definition of hiatus hernia – Hiatus is the opening or hole in the diaphragm, through which the oesophagus or the gullet passes. Oesophagus is a tube-like organ that carries food into the stomach. There is a one-way valve or a sphincter in between the lower end of the oesophagus and the stomach, which prevents the contents of the stomach from flowing back into the oesophagus.
In hiatus hernia, a piece of the upper part of the stomach pushes itself into the hiatus of the diaphragm, thus the muscle fibres of the diaphragm are not able to block the lower end of the gullet. This adversely affects the functioning of the sphincter leading to food and acid from the stomach to flow back into the oesophagus.
Hiatus hernia is of two types:
Sliding hiatus hernias – this is the more common type. These involve small hernias which slide in and out and up and down from the lower chest. The sphincter, in this case, is pushed into the hiatus of the diaphragm
Rolling hiatus hernias – in this less common type of hiatus hernia, a part of the upper stomach pokes into the hiatus or the hole in the diaphragm.

Symptoms of hiatus hernia

The main symptoms of hiatus hernia include

  • Acute heartburn
  • Problem in swallowing due to persistent acid irritation in the gullet
  • Reflux of stomach acid flowing back into the gullet causes GORD or gastro-oesophageal reflux disease.
  • Burning pain in chest which may extend till should blades. Pain aggravates with strain, forward-bending and lying down and can interfere with one’s sleep as well.
  • Voice becomes hoarse
  • Symptoms of asthma might also develop.
  • In quite a few cases, symptoms of hiatus hernia do not show up. The condition gets detected by chance during other regular investigations that the patient gets done on routine basis.

Causes for hiatus hernia

There is no specific cause for hiatus hernia, but is found commonly in people with below factors
Above 50years, as diaphragm becomes weak with age and chances of the hernia development increases.
Expecting women
Obese or overweight individuals
Any physical and strenuous activity like persistent coughing, vomiting which puts excessive pressure on the abdomen can lead to hiatus hernia.
A rare version of hiatus hernia can affect newborns, causal factor being improper development of the diaphragm or stomach.

Diagnosis for hiatus hernia

The following ways can be used to diagnose hiatus hernia:
X-ray of the digestive system to see the insides of the stomach. The person is supposed to swallow a thick paste of barium sulphate powder in water which allows clear visibility of the inside of the digestive tract.
Endoscopy – a long tube with a light source and lens attached to it is inserted down the oesophagus to reach the stomach. The optical source and the lens help to study the insides of the stomach for a clear diagnosis of hiatus hernia.

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