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Hiatal Hernia

A hiatial hernia is a rare anatomical abnormality that is usually seen in an adults and is thought to have developed over the course of several years.

What is a hiatial hernia?

A hiatial hernia is a condition in which part of the stomach protrudes through the diaphragm and up into the chest. Normally, the esophagus passes through a small hole in the diaphragm and is connected to the upper stomach just below the diaphragm. In people with a hiatial hernia, the opening of the diaphragm is larger than normal and part of the stomach pushes up past it so that the connection between the esophagus and stomach is now located above the diaphragm.

What causes hiatial hernias?

There are three common physical causes that can contribute to a hiatial hernia.

Large esophageal hiatus: The opening in the diaphragm that the esophagus normally passes through is called the esophageal hiatus. If this opening is larger than normal, the stomach can have room to push up past the diaphragm.

Permanent shortening of the esophagus: If the esophagus is shortened, possibly due to damage from acid reflux, it can pull the stomach up farther into the chest than it should be, past the esophageal hiatus.

Loose attachment of the esophagus to the diaphragm: If the connection between the esophagus and the diaphragm isn’t secure, that can also cause the stomach to slip up into the upper chest.

Although most hiatial hernias do not cause noticeable symptoms, in some cases they can lead to GERD, a condition associated with frequent heartburn and acid reflux. In these cases, repairing the hiatial hernia with surgery may help reduce the symptoms of GERD.

Types of Hiatal Hernia

A hiatal hernia is a condition in which part of the stomach protrudes through the diaphragm and up into the chest. There are two different types of hiatal hernias.

Sliding Hiatal Hernias
The most common type of hiatal hernia is referred to as a sliding hiatal hernia. This occurs when the junction of the esophagus and stomach, or gastro-esophageal junction, and part of the stomach protrude into the chest. While the gastro-esophageal junction can permanently rest in the chest, it usually only juts into the chest during a swallow. When you swallow, the esophagus contracts and shortens and pulls the stomach up. A sliding hiatal hernia will fall back down beneath the diaphragm when the swallow is finished.

Para-Esophageal Hiatal Hernias
The less common type of hiatal hernia is called a para-esophageal hiatal hernia. In these cases, the junction between the esophagus and stomach stays below the diaphragm, but part of the stomach itself actually bulges up into the chest around or beside the esophagus. A large para-esophageal hiatal hernia may cause food to stick in the esophagus after it is swallowed or cause ulcers in the herniated part of the stomach.

Most hiatal hernias cause no symptoms; however, in some cases, hiatal hernias can cause frequent heartburn or acid reflux associated with GERD. Hiatal hernias can only be diagnosed by upper gastrointestinal x-ray or endoscopy and are usually discovered incidentally while trying to address other health concerns.

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