Hiatal Hernia: Common Symptoms and Diagnosis

A hiatal hernia occurs when a portion of the stomach pushes through the diaphragm into the chest cavity. This condition affects the digestive system and can influence daily activities. The diaphragm typically has a small opening (hiatus) that allows the food pipe (oesophagus) to pass through before connecting to the stomach. When this opening enlarges or weakens, part of the stomach can protrude upward, creating a hiatal hernia.

Symptoms of Hiatal Hernia

The symptoms of a hiatal hernia vary among individuals. Some people experience no noticeable issues, while others encounter regular discomfort.

Heartburn and Acid Reflux

Stomach acid can flow back into the oesophagus, causing a burning sensation in the chest, especially after meals or when lying down. The altered position of the stomach can impair the lower oesophageal sphincter’s ability to prevent acid backflow.

Chest Pain

Pain or pressure in the chest is common, particularly after eating. This discomfort arises when the herniated portion of the stomach presses against surrounding tissues.

Difficulty Swallowing

Some people may feel as though food is stuck in their throat or chest. This sensation results from anatomical changes at the junction of the oesophagus and stomach.

Regurgitation

Food and stomach contents may flow back into the mouth, especially when bending over or lying down. A weakened barrier between the stomach and oesophagus facilitates this backward flow.

What Causes Hiatal Hernia

Several factors can contribute to the development of a hiatal hernia:

Physical Pressure: Persistent coughing, vomiting, straining during bowel movements, or heavy lifting can increase abdominal pressure, weakening the diaphragm’s opening.

Age-Related Changes: Natural weakening of muscles and supporting tissues makes hiatal hernias more common in older adults.

Anatomical Variations: A larger than average hiatus in the diaphragm can predispose some individuals to this condition.

Diagnostic Methods

Diagnosing a hiatal hernia typically involves imaging and endoscopic evaluations to confirm the condition and assess its severity.

Barium X-ray

During this procedure, the patient drinks a barium-containing liquid that coats the digestive tract. This allows the stomach and oesophagus to appear clearly on X-rays, helping doctors identify whether part of the stomach has pushed through the diaphragm.

Endoscopy

A flexible tube equipped with a small camera is passed through the mouth to examine the oesophagus and stomach directly. This technique is particularly useful for identifying structural changes, irritation, or complications associated with a hiatal hernia.

CT Scan

Advanced imaging, such as a CT scan, offers detailed cross-sectional views of the chest and abdomen. It provides precise information about the hernia’s size, location, and its effect on nearby structures.

Treatment Options

Once a hiatal hernia is diagnosed, treatment plans are tailored to address both the physical hernia and its symptoms. The choice of treatment depends on the severity of the hernia, the frequency and intensity of symptoms, and how much they impact daily life.

Non-Surgical Treatment

Dietary Modifications

Adjusting eating habits can significantly reduce symptoms. Consuming smaller, more frequent meals instead of large portions prevents excessive pressure on the stomach. Avoiding foods that trigger acid reflux, such as spicy, acidic, or fatty foods, can also be beneficial. Remaining upright for at least two hours after meals further limits the likelihood of reflux.

Medications

Over-the-counter and prescription acid-reducing medications, such as proton pump inhibitors (PPIs) and H2 blockers, are commonly used to alleviate heartburn and reduce the production of stomach acid. By minimising acid exposure in the oesophagus, these medications can prevent irritation and promote healing of any existing damage.

Surgical Treatment

Laparoscopic Repair

This minimally invasive procedure involves making small incisions in the abdomen through which surgeons insert specialised instruments. The stomach is repositioned below the diaphragm, and the hiatus (diaphragm opening) is tightened to prevent recurrence. In some cases, a portion of the stomach may be secured in place with sutures. Laparoscopic surgery is preferred for its shorter recovery time, reduced risk of infection, and smaller scars.

Open Surgery

For large or complex hernias, open surgery may be required. This technique involves a single larger incision, providing the surgeon with a clear view of the area. Open surgery is effective in addressing severe cases, such as paraoesophageal hernias, where part of the stomach may become trapped in the chest cavity. While recovery time is longer compared to laparoscopic repair, this method allows comprehensive repair of the hernia and diaphragm.

Prevention and Management

Preventing complications and managing symptoms of a hiatal hernia involve adopting a combination of lifestyle changes. Maintaining a healthy weight can reduce abdominal pressure, while proper posture when sitting or standing minimises strain on the diaphragm. Simple adjustments, such as wearing loose clothing around the waist and elevating the head of the bed during sleep, can significantly ease discomfort.

Conclusion

Hiatal hernias can affect daily life in various ways, but with proper diagnosis and a tailored treatment plan, many patients experience significant relief. Early recognition of symptoms and consultation with a healthcare provider are key to managing this condition effectively. 

If you are experiencing persistent symptoms associated with a hiatal hernia, schedule a consultation today for a comprehensive evaluation and personalised care plan.