WHAT IS A
HIATUS ("Hiatal") HERNIA?





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Unlike an abdominal (or groin) hernia, a hiatus hernia occurs in the chest area and affects the digestive system.

Where the oesophagus ('food pipe', or 'gullet') goes down, it passes the diaphragm through a gap called the hiatus. Immediately below that, it goes into the stomach which sits just below the diaphragm.

 This hiatus causes a narrowing of the opening into the stomach and this helps prevent stomach contents from going the wrong way, ie upwards, which is called reflux.

If the area of the hiatus is weak, the function of 'clamping down' on the entry to the stomach is weakened, the result being the reflux of acidic digestive juices up into the oesophagus, which is not protected against the action of these acids. The outcome of this is often a quite painful burning sensation. Other symptoms patients suffer include chest pain which may extend to just below the shoulder blades.

Unlike an abdominal hernia, there are no tell-tale visible symptoms of hiatus hernia, as the whole event occurs inside the chest. The diagnosis is established by a specialist; the combination of symptoms must be confirmed by X-ray and an endoscopy (a view using a lighted tube).

What can be done to avoid a hiatus hernia?

Whilst there is nothing that one can do to prevent the occurrence of a hiatus hernia, there are three ways of dealing with the symptoms.
 
 

Lifestyle.

There are certain things one can do, some obvious and some less so. If one can identify, for example, that certain foods aggravate the condition whilst others do not, then simple avoidance of those foods is an easy way of avoiding discomfort. 

Further, it is clear that to eat a heavy meal and promptly go and bend over digging the garden is not sensible if it is known to cause problems. Again, this is an example where one can spare one's self the symptoms by simple adjustment to the timing and choices of these activities. However, for some patients, even drinking a glass of water before lying down can cause hours of discomfort.

 The answer here may, again, be to avoid eating or drinking for an appropriate amount of time before lying down. There are also certain adjustments one can make to one's bed in order to change the angle. This can also assist in reducing the occurrences of reflux.

 The advantage of the 'lifestyle' approach is, mainly, that you might avoid medical or surgical intervention altogether and be able to live with the condition without suffering the symptoms. The disadvantages are that it may not be possible to find a 'lifestyle' that deals with the symptoms and also the inconvenience caused may be intolerable.

Some 'tips' are given later in this page, but read on first.
     

    Medicine. 

    There are several different medicines available to deal with the symptoms of hiatus hernia. They work in different ways, but are normally of an antacid type, and some work better on certain patients and others better on other patients. You should ask your doctor to suggest one or other type and, if that does not help, he may suggest a different one. 

    The advantage of the medicinal approach is that, in certain cases, this allows the patient to avoid all symptoms without too much inconvenience. The disadvantage is that it may not be desirable to take medicine for the rest of one's life.

     
      

    Surgery.

    The surgery for hiatus hernia should not be confused with the techniques described for abdominal wall hernias. They are very different procedures.

    We would say that no decision should be taken to proceed to surgery for hiatus hernia lightly. The operation is relatively complex and if possible, non-surgical remedies are preferable.

    For many cases of hiatus hernia, it is perfectly possible to end the problem once-and-for-all by an operation which tightens the hiatus area in order to keep the stomach in its correct place, below the diaphragm, and which reinstates the narrowing of the opening into the stomach, thus preventing the reflux and other symptoms. At The British Hernia Centre, we effect the procedure through an incision in the abdomen (not through the chest).

    The patient is admitted to hospital for three or four days and there follows a recuperation period of about a week. After this time, almost all patients are able to get back to normal routine without any of the symptoms of the hiatus hernia.

    Despite the very high success rate of this operation, we follow the following important steps before planning the procedure:

    a) Confirming the correct diagnosis by the means described above

    b) Ensuring that the patient has tried the alternative methods of lifestyle and medicine

Some TIPS.

There are several foods and other matters that are commonly associated with aggravating the symptoms. Before considering medicines or surgery, it is often worthwhile making changes to avoid such things as:


What to do NEXT.

We advise people who contact us from all over the world that the best course of treatment is to have the endoscopy and x-ray tests and then have the surgery (if that is what is required) performed locally. Your own family physician should be able to recommend you to a specialist in this field of hernia work who is expert in modern techniques. Unlike for abdominal wall hernias, (where it might be well worth your while to come to us from any part of the world for our specialised approach) modern and successful hiatus hernia surgery is available in most places today. The British Hernia Centre concentrates on abdominal wall hernia repair only, not hiatus hernia.
 


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