Hiatal Hernia

What is a hiatal hernia?

A hiatus is defined as a gap or passage in an anatomical part, whereas a hernia is the protrusion of an organ through a gap. When put together we are specifying the organ as the stomach with a hiatus in the diaphragm, thus a hiatal hernia is the protrusion of the stomach through a gap in the diaphragm.

There are different types?

Not to worry! At least 95% of hiatal hernias are Type 1, meaning that  where the esophagus meets the stomach (the gastroesophageal junction)  and part of the gastric cardia have moved up through the diaphragm. 

Types 2 & 3 are called paraesophageal hernias, para meaning alongside of,  thus the fundus is alongside the esophagus. Type 4 includes other bowel contents in addition to the stomach.

How did this happen?

The risk of developing a hiatal hernia increases with age and is linked to  predisposing hereditary factors, meaning that if mom or dad had it you  might have it too. Over time there is weakening of the phrenoesophageal  ligament (phrenic meaning of or related to the diaphragm) and dilation of the diaphragmatic hiatus, allowing the stomach to move where it should  not be. Things that increase the movement of the stomach include increased intraabdominal pressure (e.g. being overweight increases pressure in the abdomen), swallowing, and breathing. 

What should I do?

Most patients will have GERD (heartburn) or trouble swallowing solid foods. In order to evaluate these symptoms, your gastroenterologist will use a scope to look down your esophagus and into your stomach at which point they will be able to diagnose a hiatal hernia. Adding a proton pump inhibitor (PPI) will improve the symptoms of GERD and decrease the harmful 

effects of stomach acid on the esophagus. In addition to medications, losing weight can help decrease the intraabdominal pressure making sure the stomach stays put in the abdomen. If symptoms continue to worsen despite these conservative measures or if anything other than a Type 1 hiatal hernia is diagnosed, you may be a candidate for surgical repair.