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Hiatus Hernia

What is a Hiatus Hernia?
A hiatus hernia refers to the protusion of the stomach up into the chest through a sheet of muscle called the diaphragm (see below).

Hiatus hernias are more common in people above the age of 50. There are two common types:

> “Sliding” hiatus hernia (95%) – this occurs when lower oesophagus sphincter moves above the diaphragm with part of the stomach (diagram below).

> “Rolling” hiatus hernia (5%) – this occurs when the lower oesophageal sphincter remains fixed, and only part of the stomach herniates through into the chest wall cavity. This is also known as a “para-oesophageal” hernia, which literally means “next to the oesophagus”. Although it is less common, rolling hiatus hernias may be associated with serious complications such as twisting and strangling of the stomach. In additional, rolling hiatus hernias usually progressively enlarge over time.

> Occasionally, there is a combination of both sliding and rolling hiatus hernias.

What causes a hiatus hernia?
Anything that causes increased pressure in the abdomen can predispose to the formation of a hiatus hernia. This includes obesity, constant coughing, pregnancy, or constipation and straining.

What are the symptoms of a Hiatus Hernia?
Most people with a hiatus hernia have no symptoms. However, it can be associated with upper abdominal discomfort and gastro-oesophageal reflux. A sliding hiatus hernia can reduce the ability of the lower oesophageal sphincter in preventing acid reflux, and also in the clearance of acid once reflux has occurred.

How is a Hiatus Hernia diagnosed?
A hiatus hernia may be detected during a gastroscopy or on a barium swallow study.

What is the treatment for a Hiatus Hernia?
Treatment for a sliding hiatus hernia is only required if it is large, and there are symptoms of gastro-oesophageal reflux. Weight loss and cessation of smoking is recommended, as these can aggravate reflux symptoms. The initial treatment is with medications which reduce acid production. Surgery is occasionally necessary for a sliding hiatus hernia if medical therapy has failed.

In contrast, surgery is usually the treatment of choice for a rolling hiatus hernia due to the risk of serious complications.

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