According to the Mayo Clinic, hiatal hernias occur when part of the stomach pushes upward through the diaphragm. The diaphragm normally has a small opening, known as a hiatus, which allows the esophagus to pass through as it travels to connect with the stomach. However, the stomach can push up through this opening and cause hiatal hernias.
Causes
Hiatal hernias result when the muscle tissue around the hiatus becomes weakened, allowing the stomach to bulge up into the diaphragm. Although researchers are still unclear as to why this happens, it is believed the pressure on the stomach may contribute to the formation of hiatal hernias, according to the Mayo Clinic. In fact, the Cleveland Clinic states that experts believe this increased pressure in the stomach is caused by persistent coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain. The Mayo Clinic also lists other potential causes as injury to the area, an inherited weakness in the surrounding muscles and being born with an unusually large hiatus.
Risk Factors and Complications
According to the Mayo Clinic, hiatal hernias are more common in people who are fifty years of age or older, obese and smokers. In most hiatal hernia cases, no complications occur. However, in some cases, hiatal hernias can cause food and acid to move back up into the esophagus, resulting in heartburn and chest pain symptoms, and sometimes requires surgery.
Symptoms and Diagnosis
People with small hiatal hernias typically do not experience symptoms, according to the Mayo Clinic. However, people suffering from large hiatal hernias commonly experience symptoms such as chest pain, heartburn, frequent belching and nausea.
Doctors often discover hiatal hernias during either an x-ray of the upper digestive tract, or using a scope to see inside the digestive tract. These tests are commonly performed to determine the cause of heartburn or chest pain a patient is experiencing.
Treatment
The Mayo Clinic states most people with hiatal hernias do not require treatment, since they do not experience any symptoms. However, those who do experience symptoms may require a medication regimen, as their first line of treatment. People with hiatal hernia symptoms are typically prescribed antacids, H-2-receptor blockers, or proton pump inhibitors.
Surgery
The Cleveland Clinic reports the small amount of people who require surgery for hiatal hernias also have gastroesophageal reflux disease, or strangulated hernias. Despite the usage of medications for these conditions, sometimes symptoms do not subside and surgery is necessary. The Mayo Clinic explains that hiatal hernia surgery may involve pulling the stomach down into the abdomen and making the opening in the diaphragm smaller, reconstructing a weak esophageal sphincter, or hernia sac. For most people this is done using a single incision in the chest wall or abdomen.
