Hiatus Hernia

A hiatus hernia is when the upper part of your stomach bulges through an opening in the diaphragm.  It does not normally need treatment if it is not causing you problems.

There are two types of hiatal hernia.

1. Sliding: A small portion of the stomach, and the area where the stomach and oesophagus join, slide up into the chest through the hiatus. This is the most commonly reported form.
2. Paraoesophageal: Although the stomach and oesophagus remain in their respective places, a small portion of the stomach may bulge up into the chest, very next to the oesophagus. Rarely reported, this is a serious form of hernia, as it could strangle the stomach or cut off its blood supply.

Hiatus hernias are dynamic which means they may change in size over time getting bigger and smaller.

• Heartburn (a painful burning feeling in your chest).
• Bitter or sour taste in the mouth or throat and/or bad breath.
• Stomach pain and/or excessive gas (burping)/feeling bloated.

Note: These are symptoms of gastro-oesophageal reflux disease (GORD).

• Difficulty or pain when swallowing.
• Severe chest or abdominal pain accompanied by nausea and/or vomiting, and inability to have proper bowel movements or pass gas (these are complications of GORD or the hernia strangling - if you are experiencing this, please seek emergency medical attention).

A hiatal hernia is a condition caused due to weak muscle tissues. The upper part of the stomach bulges through an opening in the diaphragm.

Although it is not always clear what causes a hiatus hernia, it could be due to weak muscle tissues and is more common if you are over 50’s, pregnant or overweight.

Diagnosing a hiatus hernia involves imaging tests to find out the cause of heartburn or chest pain.

• Endoscopy - to check for inflammation in the digestive tract.
• Barium swallow - a type of X-ray that provides clear silhouette of stomach, oesophagus, and duodenum image.
• The Cytosponge™ or EndoSign® device - this collects cells from the oesophagus which are then tested.

Your doctor may carry out other tests alongside these including:

• Full blood count (CBC) – a blood test to check for anaemia due to blood loss.
• pH test - to measure the pH or amount of acid that flows into the oesophagus from the stomach during a 24-hour period.
• Manometry - to measure the pressure and movement inside the oesophagus.

Medical Treatment:

• If medicines from the pharmacy and changing your eating habits do not help, see a GP, who can prescribe stronger medicines.
• If stronger medicines do not work, a GP can send you for further tests to find out if your symptoms are caused by a hiatus hernia. They might also prescribe medicines for long-term GORD.
• A GP might refer you to a specialist to check if you need surgery. This usually only happens if other treatments have not worked and you keep having very bad symptoms. 

Surgery:

Keyhole surgery (also called a Laparoscopy) is usually used for a hiatus hernia. This involves making small cuts in your tummy (abdomen) under general anaesthetic.

After surgery, it usually takes:

• 2 to 3 days before you can go home.
• 3 to 6 weeks to go back to work.
• 6 weeks before you can eat what you want (you will be on a modified diet during this time).
• a few months to recover from side effects like bloating, excessive gas and difficulty swallowing.

There's a small risk (about 1 in 100) that your side effects will not go away, and you'll need more surgery.