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Hiatus hernia: types, symptoms, causes and treatment

Hiatus hernia: types, symptoms, causes and treatment

March 29, 2024

Our digestive system is one of the most important parts of our body, because it allows us to obtain the nutrients necessary for survival. One of the main organs of this system is the stomach, being the first of the digestive organs located entirely within the abdomen.

To reach it, food must pass through the esophagus, which must pass through the diaphragm through a hole called the esophageal hiatus. However, in some cases problems occur as the known as hiatus hernia, in which part of the stomach goes through said hole and it causes different problems and pains.

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Hiatus hernia: concept and main symptoms

As we have said, The esophageal hiatus is a small hole in the diaphragm that allows the esophagus to pass through it. and reach the stomach, located below the diaphragm. Under normal conditions it is the esophagus that crosses it, keeping the diaphragm separated the thoracic organs of the abdominals. However, sometimes a problem arises which comes to be called a hiatus hernia.


Hiatal hernia or hiatal hernia is a medical condition in which a part of the stomach protrudes through the esophageal hiatus , leaving a portion of it in the thorax. It is a relatively frequent problem that can generate different symptoms, although it can also occur asymptomatically. This medical condition tends to be more frequent among people between forty and sixty years of age, although it can also appear at other ages.

In cases where symptoms appear often it is frequent to manifest discomfort or burning sensation that can reach the throat known as heartburn, pain, dysphagia or swallowing difficulties, possible regurgitation of food, and gastroesophageal reflux. It is possible that respiratory difficulties and obstructions appear in the eslogue.


Although in many cases it is something mild that can not even generate symptoms, hiatal hernia it can become dangerous if it is not treated , because certain complications can arise. These complications can be a gastric perforation, the death of digestive tract tissue due to necrosis, respiratory complications or even that the lungs absorb part of the stomach contents. Sometimes bleeding also occurs, visible in black or red stools or vomiting blood, is also worrisome.

Finally, a weakening of the walls of the esophagus and stomach can occur which can culminate in Barret's esophagus, a condition that can increase the probability of suffering cancer.

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Types of hiatal hernia

They have been drawn Several classifications regarding different subtypes of hiatal hernia , observing different types.


1. Sliding or sliding hernias

It is the most common type of hiatus hernia. This subtype is characterized by the gastroesophageal junction (the part where the esophagus and stomach meet) and a part of the stomach called cardia (the uppermost part and connected to this union) protrude and cross the diaphragm, remaining located in the thorax , because the ligament that should keep the gastroesophageal junction in place does not have enough strength.

2. Paraesophageal or rolling hernia

In this subtype of hiatal hernia a part of the stomach that is not the cardia protrudes through the hiatus, which usually has a larger size than usual. The cardia and the gastroesophageal junction are in place, but part of the upper part of the stomach protrudes through the hiatus forming a small lump parallel to the esophagus .

3. Hernia of mixed hiatus

This subtype of hiatus hernia supposes the union of the characteristics of the two previous ones.

4. Hernia type 4

This type of hernia appears when it is another viscera that protrudes through the hiatus, like the colon or the spleen. They may or may not be accompanied by part of the stomach.

5. Inverted stomach

This condition is rare and extreme and it can generate serious health problems. In it, the entire stomach is in the thorax.

Causes of hiatal hernia

The reason why a part of the stomach protrudes through the hiatus can vary greatly. In some cases it is possible to find that there are malformations or congenital conditions that provoke or facilitate (For example, some people have a much larger hiatus than usual).

However, it is generally considered that this type of problem has an acquired cause.One possible explanation lies in the loss of flexibility and strength of the ligaments and musculature of the diaphragm with age.

Another possible cause is found in the Exertion of excessive efforts in the abdominal musculature or the diaphragm itself. For example people with digestive problems who have to make great efforts to defecate or people with persistent, strong and chronic cough can cause the movement and protrusion of the stomach.

Also the performance of certain surgeries can cause the hiatus to expand. It can also happen to obesity or pregnancy if the pressure in the abdominal muscles increases.

Treatment

The treatment to be applied in each case of hiatal hernia will depend to a great extent on the situation of each individual. In case there is gastroesophageal reflux (a disorder with which comorbidity is usually common) this condition should also be treated.

In some cases it is possible that treatment is not required, although it is advisable to carry out a diet in which there are little meals in which frits, fats, spicy foods, alcohol and products that increase acidity or produce gas are avoided. time that low-fat foods and products that regulate PH are increased, such as yogurt and some types of dairy products.

Some individuals require the use of different types of drugs such as antacids to reduce heartburn, histamine-2 inhibitors or proton pump inhibitors.

In the most serious cases It may be necessary to perform surgery to reposition the affected organs at the same time the hiatus is reconstructed and measures are created to regulate the intra-abdominal pressure.

Bibliographic references:

  • Pérez, J.J .; Viscarra, J.F .; and Ríos, C.G. (2017). Hiatal hernia: a diagnostic and therapeutic challenge. About a case. Médicas Vis, 30 (2): 83-88.
  • García, M. and Duménigo, O. (2002). Mixed hiatal hernia. Report of a case. Cuban Journal of Surgery, 41 (2). Havana city.

Hiatus hernia: signs, symptoms and treatment (March 2024).


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