What is a Hiatal Hernia?

Esophageal hiatal hernia is a disease caused by the abdominal cavity organs (mainly the stomach) entering the thorax through the esophageal hiatus. Esophageal hiatal hernias are the most common in diaphragmatic hernias, accounting for more than 90%, and are classified as gastrointestinal diseases. Patients with esophageal hiatal hernias may be asymptomatic or mild, and their severity is not related to the size of the hernia sac or the severity of esophageal inflammation. A hiatal hernia and reflux esophagitis can exist simultaneously or separately. The disease can occur at any age, but the appearance of symptoms increases with age. The incidence of this disease in the general population was 0.52%, and in routine gastrointestinal X-ray barium meal examination of patients with suspicious hiatal hernia symptoms, the detection rate of hiatal slip hernia was 11.8%. In recent years, special body pressure method has been used in X-ray examination, and its detection rate can reach 80%. Because the disease is mostly asymptomatic or mild, it is difficult to determine its exact incidence. There are more women than men in this disease, ranging from 1.5 to 3: 1.

Basic Information

English name

hiatus hernia

Visiting department

Thoracic Surgery

Multiple groups

female

Common locations

esophagus

Common causes

Esophageal hypoplasia, muscle atrophy or weakened muscle tone, long-term increased abdominal pressure, surgery, etc.

Common symptoms

Stomach contents dislike, epigastric fullness, belching, pain, etc.

Causes of hiatal hernia

1. Congenital factors of esophageal hypoplasia.

2. Structure of esophageal hiatus, such as muscle atrophy or weakened muscle tension.

3. Acquired factors such as long-term increased abdominal pressure, such as pregnancy, peritoneal effusion, chronic cough, habitual constipation, etc., can cause the hernia of the stomach to enter the diaphragm and form a hiatal hernia.

4. Postoperative hiatal hernia, such as surgery on the upper stomach or cardia, destroys the normal structure can also cause hernia.

5. Traumatic hiatal hernia.

Clinical manifestations of hiatal hernia

Gastroesophageal reflux symptoms

It manifests burning sensation behind the sternum or under the xiphoid process, dislike of the stomach contents, fullness of the upper abdomen, belching, pain and so on. The nature of the pain is mostly a burning sensation or acupuncture-like pain, which can radiate to the back, shoulders, neck, etc. Lying flat, eating sweets, and acidic foods can all induce and aggravate symptoms. This symptom is more common in sliding hiatal hernias.

2. Complications

(1) Hemorrhagic hiatal hernia can sometimes bleed, mainly due to esophagitis and hernia cystitis, mostly chronic small amount of bleeding, which can cause anemia. Hernias in the stomach and intestines can cause vomiting and melena.

(2) Reflux esophageal stenosis: In patients with reflux symptoms, a small number of generators are qualitatively narrow , causing symptoms such as difficulty swallowing, swallowing pain, and vomiting after eating.

(3) Hernia sac incarceration is commonly found in paraesophageal hernias. Patients with hiatal hernias who have sudden and severe epigastric pain with vomiting cannot swallow at all or have major bleeding at the same time, suggesting the occurrence of acute incarceration.

3. Hernia sac compression symptoms

When the hernia sac compresses the heart, lungs and mediastinum, it can produce symptoms such as shortness of breath, palpitations, cough, and cyanosis. Squeezing food or difficulty swallowing behind the sternum can be felt when oppressing the esophagus.

Hiatal hernia

1. X-ray inspection

It is still the main method to diagnose hiatal hernia. For reversible hiatal hernias (especially mild ones), a negative test can not rule out the disease. Clinically highly suspicious patients should repeat the test and take special positions, such as supine head, low feet, etc., and the barium meal can show Direct signs and indirect signs.

2. Endoscopy

The diagnosis rate of esophageal hiatal hernia by endoscopy is higher than before, and it can be supplemented with X-ray examination to assist diagnosis.

3. Esophageal manometry

In esophageal hiatal hernias, esophageal manometry may have abnormal patterns to assist diagnosis.

Diagnosis of hiatal hernia

Because the disease is relatively rare and has no specific symptoms and signs, diagnosis is difficult. Suspicious patients with symptoms of gastroesophageal reflux, older, obese, and symptoms and body position should be paid attention to, and the diagnosis needs to be checked with some equipment.

Treatment of hiatal hernia

Medical treatment

For small sliding hernias and those with mild reflux symptoms. The principle of treatment is to eliminate the factors of hernia formation, control gastroesophageal reflux, promote esophageal emptying, and alleviate or reduce gastric acid secretion.

(1) Lifestyle changes Reduce food intake, and focus on high-protein, low-fat diets. Avoid coffee, chocolate, and alcohol. Take your head high, feet low while sleeping, and lift the head of the bed when lying. Avoid bending, wearing tights, vomiting and other factors that increase intra-abdominal pressure. Obese people should try to reduce weight, have chronic cough, long-term constipation should try to treat. For those with asymptomatic hiatal hernia and small hiatal hernia, the above treatment can be given appropriately.

(2) Drug treatment: For those who have symptoms of gastroesophageal reflux such as chest pain, post-sternal burning, acid reflux, or postprandial nausea, in addition to the above precautions, anti-reflux and protective esophageal mucosa drugs, prokinetic drugs, etc.

2. Surgical treatment

(1) Indications for surgery Esophageal hiatal hernia with reflux esophagitis, the medical treatment is not effective. Esophageal hiatal hernia is accompanied by pyloric obstruction and duodenal stagnation. paraesophageal hernia and giant hernia. suspensory hiatal hernia.

(2) Principles of surgery Reduction of hernia contents. Repair loose and weak esophageal hiatus. prevent gastroesophageal reflux. keep the gastric outflow tract unobstructed. Treat concurrent complications.

(3) Surgical methods : There are many surgical methods for treating esophageal hiatal hernias, mainly hernia repair and anti-reflux surgery.

Prevention of hiatal hernia

Preventing long-term increase of abdominal pressure, such as peritoneal effusion, chronic cough, habitual constipation, etc., can reduce the occurrence of hiatal hernia.