Hiatal hernia – what is it, symptoms, causes, types. How to treat and minimize symptoms?

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A hiatal hernia is a digestive system disorder that involves the transfer of a part of the stomach to the chest. The hernia manifests itself as pain, heartburn, belching, and hoarseness. The causes of this ailment are primarily an increase in pressure in the abdominal cavity, e.g. when sneezing or vomiting.

Hiatal hernia – what is this disease?

A hiatal hernia is a disorder of the anatomy of the digestive system. It is manifested by the passage of the abdominal organs to the chest through the channel in the diaphragm. The disease may be asymptomatic. However, some patients develop disorders such as retrosternal pain, heartburn and belching. If left untreated, it may cause, for example, narrowing of the esophagus, erosions of the esophageal mucosa and hernia arrest.

Hiatal hernia – history

Hiatal hernia was first described in 1786 by Gian Battista Morgagani, an Italian anatomist. Before large-scale radiological examinations began, the condition was considered a rare disease. In 1926, the disease classification was created – its author was Ake Akerlund. The doctor distinguished 3 types of hiatal hernia, which are: hernia at congenital shortened esophagus, periophageal hernias, hernias where the esophagus is not shortened.

The way the disease is treated has changed over the course of the XNUMXth century. Paolo Postempski and Emil Samuel Perman are the authors of the technique consisting in the production of a dermal-musculo-costal-pleural flap of one of the ribs. Yet another treatment technique was to excise the dermal-muscular flap with the base downwards and excise several ribs. During the operation, surgeons turned off the phrenic nerve or turned it off only temporarily.

Another revolution in the treatment of a hiatal hernia took place in 1925. Then Sauerbruch proposed cutting the phrenic nerve when the hernia was trapped – the procedure was performed only in patients who could not be treated in any other way. One should also mention Leonard Landois, a German physiologist, popularizer of closing the diaphragm defect with a skin flap and a subcutaneous flap.

Rudolf Nissen and Rene Toupeta played an important role in the treatment of hiatal hernia surgery. Thanks to them, an operation from the abdominal approach was started – for many years it was a standard surgical procedure. Also today, the basic elements of the operation are the drainage of the contents of the hernial sac to the abdominal cavity, initiated by the aforementioned doctors.

1. Find out more about an inguinal hernia

Hiatal hernia – symptoms

Symptoms of a hiatal hernia are:

1. heartburn,
2. vomiting,
3. pain in the chest,
4. swallowing problems
5. morning crunch
6. dry cough,
7. wheezing
8. belching with gastric contents,
9. dizziness.

The patient experiences a regurgitation of stomach acid that ends up in the esophagus – as a result, it causes irritation and thus inflammation of the esophageal mucosa. Then there is a burning sensation in the area of ​​the heart, behind the breastbone, and there is pressure. The patient also experiences shortness of breath and sweats excessively. Symptoms of the disease appear about an hour after a meal. Retention of food in the esophagus can also be symptoms of a hiatal hernia.

The disease is quite common. Elderly people suffer from it most often – the risk of it increases with age. Even the small size of the hernia allows it to be fully recognized. When its symptom is the retention of the contents of the hernia in the chest, then the risk that the disease may be fatal increases significantly.

Hiatal hernia – causes

The disease has not yet been fully understood, so it is not possible to identify specific causes. It occurs in both children and adults – in the second case, much more often. Among adults, a factor contributing to the development of the disease is an increase in pressure in the abdominal cavity – the consequence of this condition is pressure from the bottom of the intestines and stomach against the diaphragm.

A hiatal hernia is more common among obese people who lead a sedentary lifestyle. Age is also a factor contributing to the development of the disease – the risk of developing the disease increases after the age of 50. Another such factor is cigarette smoking. We divide the disease into congenital and acquired.

Hiatal hernia and its types – sliding hernia

It is the most common type of hiatal hernia, accounting for about 90% of all cases. The patient is displaced into the mediastinum and stomach. Other symptoms include a weakening of the muscle tone of the lower esophageal sphincter, which results in a disorder of the mechanism that protects the esophagus from gastric leakage. The symptoms of this condition are similar to those of acid reflux disease.

A patient with a sliding hernia has heartburn, returns food, has difficulty swallowing, and experiences pain in the chest area. Other symptoms include shortness of breath, palpitations and epigastric pain. The timbre of the voice may also change slightly due to the accompanying hoarseness and recurrent cough. Not everyone has the same symptoms. It is also often easy to confuse this disease with other conditions with similar symptoms.

Hiatal hernia and its types – periophageal hernia

It consists in the passage of the cardia and the main parts of the stomach. This type of hernia very often does not give any symptoms, but as a large part of the stomach moves to the mediastinum, shortness of breath and heart problems may occur. In order to make a diagnosis, it is necessary to perform a radiological and endoscopic examination.

Untreated hiatal hernia causes gastric mucosa bleeding. It also causes similar symptoms to a sliding hernia. To diagnose the disease, first of all, gastrofiberoscopy is used, i.e. examination of the upper gastrointestinal tract, which includes the esophagus, stomach and duodenum.

Hiatal hernia and its types – treatment

The method of treatment depends on the stage of the disease. Pharmacological treatment based on proton pump inhibitors is the most commonly used. An equally important element of therapy is the use of a proper diet, such as for example in reflux disease. When pharmacological treatment is insufficient, the doctor may decide to perform surgery – often one of the last resort when the condition is severe.

The surgical procedure can be performed, for example, by the traditional method or with the use of modern technologies, such as the da Vinci surgical robot. The aim of the operation is to alleviate the symptoms of the disease, e.g. by stabilizing the stomach in the abdomen. The procedure also strengthens the ring surrounding the hiatus in the diaphragm. The surgical procedure with the da Vinci robot differs from the usual procedure in that the surgeon does not have to be directly at the operating table.

Treatment of a hiatal hernia during da Vinci surgery is also performed under general anesthesia. The surgeon first makes several necessary incisions in the abdominal wall of the patient to insert the instrument attached to the robot arm and the camera through them. This is also supposed to allow him to enter the hernia itself. It then creates a cuff from the front and back walls of the stomach around the esophagus to strengthen the lower esophageal sphincter.

In the next stage, the opening of the hernia is sutured. An important test performed during the operation is checking the condition of the stomach and esophagus – this is done endoscopically. The esophagus must be of the right length for anti-reflux treatment. The da Vinci robot is a precise device – this means that the risk of a possible surgical injury is lower.

In what cases should hiatal hernia surgery be performed?

Surgical treatment is indicated in cases where conservative treatment does not bring any result or cannot be used. Another indication for surgery is gastric displacement, especially when it is significant. In this case, one of the methods of treatment is fundoplication by Nissen’s method.

Fundoplication using the Nissen method is suturing the mobilized fundus of the stomach around the lower esophagus. The doctor cuts the abdominal wall and inserts the laparoscope and the instrument used during the operation through it. The advantage of the procedure is the low risk of complications – however, there is a risk of bleeding, abscess or wound infection. The mortality associated with the operation is small – most often people who have previously had serious comorbidities die.

Before the operation, the patient should be properly prepared. He cannot eat solid food and drink nothing 4 hours before the procedure. The patient can go home already 24 hours after the procedure. What’s more, after just 6 hours, she can get up on her own and consume liquids, e.g. water, weak coffee (without sugar) and bitter tea. Solid food can be eaten 24 hours after the procedure.

The advantage of the Nissen method is to significantly reduce the symptoms of the disease. The patient no longer feels pain in the chest, the feeling of disgust is reduced and the bad smell from the mouth disappears. All this means that the patient’s quality of life improves and, for example, he does not have to take medications later. It also has the advantage that the risk of developing esophageal cancer and inflammation of the esophagus is reduced.

How To Treat A Hiatal Hernia?

If the case does not require surgery, conservative treatment is applied. The patient then receives drugs that soften the stool, accelerate the passage of food from the stomach into the duodenum, limit the production of stomach acid or neutralize it. Weight reduction is an important part of treatment. However, diet and exercise alone are not always sufficient, although they are helpful – nevertheless they are considered to be prophylactic measures, alleviating symptoms.

How can I minimize the symptoms of a hiatal hernia?

A sick person should limit the number of meals eaten to 3 large dishes a day. She should also not eat right before going to bed, give up stimulants such as cigarettes, reduce body weight. It is also recommended that the patient be kept to a minimum bending of the head. It should also sleep on a pillow with a thickness of about 10 cm – this will ensure that the food content will not regress.

What diet should people with a hiatal hernia follow?

The patient should follow an easily digestible diet, which is also the most popular therapeutic diet. It should be used not only by people with digestive system diseases, but also by seniors, whose digestive system efficiency decreases with age. Eating light meals gives you a feeling of well-being and supports the healing process of a hiatal hernia.

An easily digestible diet must not contain hard-to-digest products that cause flatulence. This means that you should give up smoked products, hot spices and pickles. It is also inadvisable to eat products with a lot of fiber – however, it is an important part of a balanced diet, so it is best to use its various sources. It is also worth giving up raw vegetables, whole grain cereal products that irritate the digestive tract.

Permitted foods on a light diet that people with hiatal hernia can eat are:

1. fruit – apples, melons, apricots, oranges, but without seeds and skins,
2. meat – lean beef, veal, rabbit, chicken, turkey,
3. fish – trout, flounder, pike perch,
4. eggs – soft, steamed or egg omelette,
5. dairy products – kefir, yoghurt, curdled milk, natural yoghurt, sweet milk,
6. drinks – still water, diluted fruit juices.

What herbs to use to treat a hiatal hernia?

Although the herbs are primarily used prophylactically, they can help treat heartburn, which is also a symptom of a hiatal hernia. Heartburn is a burning sensation in the esophagus and breastbone. May cause a bitter taste in the mouth, chest pain, vomiting and stomach pain. Herbs to help treat the condition include:

1. Mugwort is a Christmas tree

The plant has found wide application in folk medicine. The leafy stems are the most valuable part of the plant. They are used to prepare an infusion that strengthens the body, supports the production of bile and its flow, regulates digestion and supports the work of the liver. It is also diuretic, diaphoretic and has anti-inflammatory, antibacterial and antiviral properties. It also stimulates the appetite, removes parasites from the intestines and even regulates excessively heavy periods.

Mugwort helps to heal any digestive ailments. To prepare the infusion, pour 1-2 teaspoons of the herb with boiling water and cover with a saucer to make the infusion stretch – it should not take longer than 10 minutes. It is advisable to drink the infusion 2 to 3 times a day after meals. The mugwort can also be used as a seasoning for meat and fish dishes – thanks to it they will be digested faster. Important – the infusion cannot be drunk by pregnant and breastfeeding women.

1. Marshmallow

The plant, thanks to its anti-inflammatory, softening and coating properties, is helpful in the treatment of hiatal hernia. Marshmallow is effective in the treatment of acidity, heartburn, peptic ulcer disease and constipation. It also helps to rinse the mouth and is a natural cosmetic that is used to treat skin problems.

For the preparation of marshmallow root infusion, prepare 2-3 tablespoons of the root and pour two glasses of cooled water over it. In order for the infusion to swell, it should be set aside for about 8 hours. When it is stretched, it is enough to strain the drink and drink 1-2 glasses a day in several portions. Medicinal marshmallow or products based on it should not be used by pregnant and breastfeeding women.

1. Plantain

The use of lanceolate for hiatal hernia problems relieves gastric hyperacidity. The plant is helpful in treating recurring heartburn problems. It also increases the activity of cells of the immune system and protects the liver from damage – so it can also be used in the case of duodenal and stomach ulcers.

To prepare an infusion of cut leaf, put 1 tablespoon of plantain in a pot. Pour it all over with a glass of water and boil it over low heat – the infusion should not be boiled for more than 5 minutes. Finally, strain it and wait 15 minutes until it is ready to drink. The recommended daily dose of the infusion is half a glass 2 times a day. To prepare an infusion of ground leaf, pour 1 teaspoon of powder into 40 ml of hot water – drink it with sediment 2 or 3 times a day.

1. Common chamomile

Flowers are the medicinal raw material of the common chamomile. It soothes bloating and digestive problems. It can be used to relax the digestive system and to lower blood glucose levels. It also has calming properties, so it soothes too much nervous tension, which is one of the causes of heartburn. It also improves the functioning of the intestines, digestion and regenerates damage to the gastric membrane.

To prepare the infusion, pour 1 or 2 teaspoons of dried flowers into a glass of hot water. For the infusion to infuse, cover it for 10 or 15 minutes. Unlike the plants listed above, you can drink chamomile without restrictions, also when treating a hiatal hernia. Moreover, pregnant women and nursing women can also drink it. Nevertheless, caution should be exercised when taking anticoagulant medications concomitantly.

1. Fennel

The plant has found application in the treatment of various diseases. Currently, it serves primarily as an antidote to digestive problems, inflammation and diseases of the immune system. It has an antioxidant effect, reduces pathogens, so it is helpful not only in the prevention of hiatal hernia, but also in the prevention of lactation problems and sore throats.

1. Lemon balm

Lemon balm is one of the most popular herbs for calming down. It has long been used in folk medicine as a remedy for painful periods and digestive problems. It also improves memory, concentration and nausea in pregnancy. Lemon balm oil is also bactericidal and fungicidal. It is helpful in the treatment of nervous agitation, anxiety and vegetative neurosis.

The plant has a calming effect and helps in the treatment of insomnia. Due to the fact that it stimulates the production of bile, regulates digestive processes and lowers blood pressure, it is effective in treating heartburn. To prepare the infusion, pour 1 tablespoon of lemon balm with 1 cup of boiling water and leave it covered for 20 minutes – like chamomile, lemon balm can be drunk without restrictions.

1. Grower

The plant has anti-inflammatory and antibacterial properties and has many valuable pro-health properties. It has a positive effect on the digestive system and is often recommended for people with stomach ulcers. Calico helps to heal digestive ailments. It is a natural remedy for one of the vices hernias, i.e. recurrent heartburn. Gojnik contains, among others potassium, sodium, iron, zinc, magnesium and flavonoids.

To prepare the infusion, you need 1-2 teaspoons of the herb – pour boiling water over it and leave it covered for about 10 minutes. Drink the infusion only when it has cooled down. Everyone can drink the gentleman. There are no contraindications for pregnant women and breastfeeding women to use the herb of the herb.

1. Tansy

Tansy is a remedy known in folk medicine for digestive ailments. It is especially helpful in treating liver ailments that occur after eating fatty foods. It has a diuretic and carminative effect and stimulates the secretion of gastric, pancreatic and intestinal juices. Interestingly, it used to be the basis for the production of, among others tinctures.

To prepare a tincture of tansy, add 1 tablespoon of flowers and pour 1 cup of boiling water over it. The infusion should be set aside until it is stretched – e.g. for 30 minutes. It is best to drink it 2-4 times a day, a glass. The infusion should not be drunk by pregnant women and breastfeeding women – tansy has a miscarriage effect! It should also not be combined with alcohol. Overdose causes seizures, nausea, dizziness and vomiting.