Although this condition is benign, it can cause complications, so it should be monitored and may require surgery. A hiatal hernia can occur at any age, but usually occurs after the age of 60.

What is a hiatal hernia?

“It is an anatomical anomaly where part of the stomach passes into the chest through the esophagus. It can be temporary or permanent.

There are two types of hernia:

–The sliding onewhich represents the vast majority of hiatal hernias and is defined by the passage of the gastroesophageal junction into the mediastinum.
–Paraesophageal herniasin which the gastroesophageal junction remains in place but part of the stomach (vault) rises into the mediastinum.

Also, other organs such as the spleen and the intestine can be carried away” as stated by Mr. Stamatis Apergis, Director of Surgery at the Metropolitan Hospital.

What are the causes and symptoms of hiatal hernia?

With age, the ligaments that hold the stomach in place loosen, while other causes are: obesity – as excess weight increases the loosening of the ligaments – and smoking.

“Most hiatal hernias are asymptomatic and are discovered incidentally during an endoscopic examination. However, some can cause gastroesophageal reflux.

Although it is often asymptomatic, some symptoms may alert us, such as: pain and burning behind the sternum, a feeling of fullness (bloating), repeated belching (belching), or hiccups, reflux and vomiting with an acidic taste, bad breath, bad taste in the mouth, fatigue and a feeling of shortness of breath and finally cardiac arrhythmias”, he emphasizes.

How is a hiatal hernia diagnosed?

“There are many ways to approach the diagnosis of hiatal hernia:

Plain x-ray after ingestion of barium (a preparation containing iodine visible on X-rays), an examination useful in investigation and study.

Endoscopic study (gastroscopy) useful in investigating the esophagus and stomach.

Computed Tomography after swallowing gastrografin, a test that allows us to diagnose the type of hiatal hernia”, explains the specialist.

Complications of hiatal hernia

The complications caused by the condition are varied and some must be treated immediately.

Large hiatal hernias can cause dysphagia (difficulty swallowing) and vomiting. Also, in some cases, they cause inflammation of the esophagus – so-called esophagitis – or even ulcers, and they can also increase the risk of cancer. It can also cause bleeding leading to anemia. Finally, paraesophageal hiatal hernia can cause gastric torsion, a very serious complication.

What is the treatment for hiatal hernia?

“A hiatal hernia will not go away if left untreated and the appropriate treatment is surgery.

However, drug management of GERD is necessary and is generally sufficient for the patient. Proton pump inhibitor medications are prescribed to reduce acid reflux.

If the sliding hiatal hernia is less than 5 cm and does not cause complications, surgery is not indicated.

For a large hiatal hernia with persistent symptoms, then there is a strong indication for surgery. Regarding paraesophageal hiatal hernias, surgical treatment is necessary. During the operation, the first concern is to return the stomach to its position, to converge the legs of the diaphragm and to construct an anti-reflux valve. Surgery is an effective treatment with an estimated success rate of 90%, with complete elimination of symptoms,” concludes Mr. Apergis.