Hiatal hernia
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A hiatal hernia, referred to in medical literature as a hiatal hernia of the diaphragm, is a condition involving the displacement of a part of the stomach into the chest cavity through an enlarged esophageal hiatus of the diaphragm. It is one of the most common pathologies at the esophagogastric junction, particularly in individuals over the age of 50. In many cases, it is asymptomatic and is often discovered incidentally during imaging or endoscopic examinations. However, in some patients, it leads to significant upper gastrointestinal tract symptoms, including chronic heartburn and gastroesophageal reflux. Understanding the mechanism of formation, symptoms, and treatment principles of a hiatal hernia is crucial for proper diagnosis and prevention of complications.
Stomach hernia - what is it
A hiatal hernia is a condition in which a part of the stomach moves above the diaphragm, into the chest cavity, through the anatomical opening in the diaphragm known as the esophageal hiatus. Under normal conditions, only the esophagus passes through the esophageal hiatus, while the stomach remains in the abdominal cavity. Weakening of the diaphragm's supporting structures or increased intra-abdominal pressure can promote the displacement of organs.
There are several types of hiatal hernia, the most important being:
Sliding (axial) hernia
-
the most common form (about 90% of cases),
- the gastroesophageal junction, along with a part of the stomach's cardia, moves into the chest cavity,
- often coexists with gastroesophageal reflux disease (GERD).
- less common but potentially more dangerous,
- the gastroesophageal junction remains in place, while part of the stomach's fundus moves next to the esophagus,
- associated with the risk of gastric incarceration and ischemia.
- combines features of both sliding and paraesophageal hernias.
Factors that contribute to the development of a hiatal hernia include:
- age-related weakening of the diaphragm,
- chronic increased intra-abdominal pressure (obesity, pregnancy, chronic constipation),
- chronic cough,
- lifting heavy weights,
- congenital structural abnormalities of the esophageal hiatus.
Stomach hernia - symptoms
The symptoms of a hiatal hernia are varied and largely depend on its type and degree of advancement. In many patients, especially those with a small sliding hernia, the condition may be asymptomatic.
The most common symptoms include:
- heartburn - a burning sensation behind the breastbone, which intensifies after meals or when lying down,
- gastroesophageal reflux - the backflow of acidic stomach contents into the esophagus,
- pain or discomfort in the upper abdomen and behind the breastbone,
- feeling of fullness after eating,
- belching, sour taste in the mouth,
- nausea, less commonly vomiting.
In more advanced cases or with a paraesophageal hernia, alarm symptoms may occur, such as:
- difficulty swallowing (dysphagia),
- chest pain mimicking coronary heart disease,
- shortness of breath after meals,
- iron deficiency anemia (due to chronic microbleeds),
- sudden, severe pain in the upper abdomen - which may indicate a trapped hernia.
Untreated hiatal hernia, especially when coexisting with reflux, can lead to complications such as:
- esophagitis,
- esophageal ulcers,
- esophageal strictures,
- Barrett's esophagus (a precancerous condition).
Stomach hernia - treatment
Treatment of stomach hernia depends on the type of hernia, the severity of symptoms, and the presence of complications. In many cases, the approach is conservative, while surgical treatment is reserved for specific indications.
Primarily used for patients with a sliding hernia and reflux symptoms. It includes:
1. Lifestyle and Dietary Modifications
- weight reduction in overweight individuals,
- eating smaller, more frequent meals,
- avoiding meals before bedtime (at least 2–3 hours),
- avoiding alcohol, coffee, chocolate, fatty and spicy foods,
- elevating the head of the bed,
- quitting smoking.
2. Pharmacotherapy
- medications that reduce stomach acid secretion (e.g., proton pump inhibitors),
- antacids,
- medications that improve gastrointestinal motility (in selected cases).
The goal of conservative treatment is symptom control, not the reversal of the hernia itself.
Surgical Treatment
Indications for surgical treatment include:
- paraesophageal hernia,
- lack of effectiveness of conservative treatment,
- recurrent reflux complications,
- risk of stomach incarceration,
- significant deterioration in the patient's quality of life.
The most commonly used surgical techniques are:
- laparoscopic repositioning of the stomach into the abdominal cavity,
- narrowing of the esophageal hiatus,
- fundoplication (creating a cuff from the stomach's fundus around the lower esophagus to prevent reflux).
These procedures are characterized by high effectiveness and a relatively short recovery period, but require appropriate patient qualification.
