Hiatal Hernia

Hiatal Hernia

What does a hiatal hernia feel like (symptoms and signs)?

Hiatal hernias do not cause symptoms, and most are found incidentally when a person has a chest X-ray or abdominal X-rays, including;

  1. An upper GI series and CT scans in which the patient swallows barium or another contrast material.
  2. It also is found incidentally during gastrointestinal endoscopy of the esophagus, stomach, and duodenum (EGD).
  3. If symptoms do occur, they are due to gastroesophageal reflux disease (GERD) where the digestive juice containing acid from the stomach moves up into the esophagus.

Unfortunately, the esophagus does not have a similar protective lining. Instead, it relies on the lower esophageal sphincter (LES), a band of muscle located at the junction of the stomach and esophagus, and the muscle of the diaphragm surrounding the esophagus to act as a valve to prevent acid from refluxing from the stomach into the esophagus.

Moreover, to the esophageal sphincter (LES), the normal location of the stomach and esophageal junction within the abdominal cavity is important in keeping acid where it belongs. There is increased pressure within the abdominal cavity compared to the chest cavity, particularly during inspiration which would normally cause the acid and contents from the stomach to reflux back into the esophagus, but the combination of the pressure exerted within the lower mostly is from the esophageal sphincter (LES), and the muscle of the diaphragm create a zone of higher pressure that keeps stomach acid in the stomach.

In the situation of a sliding hiatal hernia, the gasatroesophageal and esophagus junction move above the diaphragm and into the chest, and the portion of the higher-pressure zone due to the diaphragm is lost. Acid is allowed to reflux back into the esophagus causing inflammation of the lining of the esophagus. 

The symptoms of gastroesophageal reflux disease (GERD) include

  1. heartburn, 
  2. chest pain or burning,
  3. nausea,
  4. vomiting or retching (dry heaves)
  5. burping
  6. waterbrash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid

What makes symptoms of a hiatal hernia more painful and worse?

  1. Symptoms of a hiatal hernia usually are worse after meals and may be made worse when lying flat, which may resolve with sitting up or walking.
  2. In some people with a hiatal hernia, it refluxes into the lower esophagus which sets off nervous reflexes that can cause a cough or even spasm of the small airways within the lungs people.
  3. Rarely, some people with a hiatal hernia may feel reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing
    1. coughing spasms,
    2. asthma, or
    3. repeated lung infections including pneumonia and bronchitis.

People of any age can get a hiatal hernia from infants to the elderly. Fortunately, it is very rare.

What is a paraesophageal hiatal hernia? What are its symptoms and signs?

Usually, people with a paraesophageal sphincter have no symptoms of reflux because the gastroeophageal esophagus junction remains below the diaphragm, but if the hernia is large, the way the stomach rotates into the chest, there is the possibility of volvulus of the stomach in which the stomach twists upon itself. Fortunately, paraesophageal hernias are relatively uncommon.

Rarely, gastric volvulus of the stomach in which an abnormal rotation of the stomach more than 180 degrees is a surgical emergency and causes difficulty with

  1. painful swallowing,
  2. chest pain, and
  3. vomiting.