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Hiatal Hernia

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What is Hiatal Hernia?

A hiatal hernia is a condition in which a part of the stomach protrudes through an opening called the esophageal hiatus, located in the diaphragm. The diaphragm is a muscle that separates the chest from the abdomen and has an opening through which the esophagus passes. When there is a weakness or enlargement of the esophageal hiatus, the stomach can slide up and lodge in the thoracic cavity.

How does it occur?

A hiatal hernia can be caused by the weakening of the muscles around the esophageal hiatus, allowing a part of the stomach to move upwards. This weakening can be due to factors such as age, obesity, pregnancy, excessive physical exertion, or chronic intra-abdominal pressure.

What are the symptoms?

The symptoms of a hiatal hernia can range from mild to severe and include:

  • Heartburn: a burning sensation or discomfort in the chest, caused by acid reflux from the stomach to the esophagus, which can intensify after meals or when lying down.
  • Regurgitation: return of the stomach contents to the esophagus, resulting in a bitter taste in the mouth.
  • Chest pain: can be confused with heart pain, as it can be similar to a discomfort in the chest.
  • Difficulty swallowing: feeling that food is getting stuck in the esophagus.
  • Chronic cough or hoarseness: due to irritation of the esophagus by acid reflux.

How is the diagnosis made?

The diagnosis of a hiatal hernia can be made through tests such as:

  • Upper digestive endoscopy: a flexible tube with a camera is inserted into the esophagus to view the esophageal hiatus and the stomach, allowing the presence of the hernia to be identified.
  • Esophageal manometry: these tests evaluate the functioning of the esophagus and the pressure of the lower esophageal sphincter.
  • Contrast radiography: a contrast liquid is ingested so that the doctor can observe the movement of the liquid through the esophagus and the stomach.

What is the treatment?

The treatment of a hiatal hernia can involve both lifestyle measures and medical interventions. Some treatment options include:

  • Dietary changes: avoid foods that can trigger acid reflux, such as fatty, spicy, and acidic foods. Eating smaller meals and avoiding lying down immediately after eating is also recommended.
  • Medications: the use of antacid medications or proton pump inhibitors can help reduce stomach acid production and relieve symptoms.
  • Surgery: in severe cases where symptoms are not controlled with conservative measures, surgery may be necessary to correct the hiatal hernia. The surgery involves replacing the stomach to its correct position and reinforcing the esophageal hiatus.

It is essential to seek medical guidance for the correct diagnosis and establishment of the most appropriate treatment for each case of hiatal hernia. The specialist doctor will evaluate the symptoms, the severity of the hernia, and the individual conditions of the patient to determine the best therapeutic approach.

The Figure was partly generated using Servier Medical Art, provided by Servier, licensed under a Creative Commons Attribution 3.0 unported license.


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