What Is a Hiatal Hernia and How Is It Treated?

A hernia is a weak point in the wall of the abdominal cavity. There are many different types of hernias. For example, an umbilical hernia occurs near the belly button area. It may look like a small swelling that we commonly describe as an “outie.”

What Is a Hiatal Hernia? AdventHealth board-certified general and bariatric surgeon, Rishi Ramlogan, MD, FASMBS is here to help us understand more about hiatal hernias and how they’re treated. Dr. Ramlogan explains:

“A hiatal hernia is a bit different. It’s not something we can easily notice from direct observation or a physical exam. It occurs through the diaphragm. The diaphragm is a sheet of muscle that separates your abdominal cavity from your chest cavity. The chest cavity contains organs such as your heart, lungs and esophagus. Your abdominal cavity contains organs such as the stomach, liver and intestines.”

Dr. Ramlogan continues, “There is a natural opening in the diaphragm called the hiatus. This allows the esophagus to pass from the chest cavity into the abdominal cavity. Once in the abdomen, the esophagus empties into the stomach. Sometimes the hiatus stretches and enlarges. This may cause part of the stomach to move upward into the chest cavity, where it does not belong. This can result in several symptoms, including heartburn, regurgitation, shortness of breath, abdominal pain and even chest pain.”

There are different types of hiatal hernias. The most common is a sliding hiatal hernia, where the stomach and lower esophagus slide up into the chest. A less common but more serious type is a paraesophageal hernia, where part of the stomach pushes up next to the esophagus and can become trapped.

What Causes a Hiatal Hernia?

“If you have a hiatal hernia, it’s unlikely that you did anything to cause it,” emphasizes Dr. Ramlogan. A hiatal hernia usually occurs due to one of the following reasons:

• Age-related weakening of the diaphragm
• Being born with a larger-than-normal hiatal opening
• Increased pressure in the abdomen due to pregnancy, obesity or straining

Diagnosis and Treatment for Hiatal Hernias

“To get an accurate diagnosis of a hiatal hernia, your doctor may recommend a barium swallow,” says Dr. Ramlogan. This is a simple test that involves drinking a special liquid while X-rays are taken.

Your doctor may also perform an endoscopy. This involves inserting a long, thin, flexible camera through the mouth while the patient is asleep. This allows the doctor to take a close-up look at your esophagus and stomach.

Hiatal Hernia Treatment Options

If you have acid reflux, your doctor may prescribe acid-reducing medications to help control your symptoms.

Sometimes, symptoms may become uncontrolled with medications alone. Surgery may also be recommended if you have:

• A large hiatal hernia
• Anemia or bleeding caused by irritation in the stomach
• Paraesophageal hernia that is at risk for twisting or obstruction
• Severe reflux that does not improve with medication
• Trouble swallowing

Dr. Ramlogan explains, “These operations are usually done using a minimally invasive approach. This is called laparoscopic surgery and is often performed with the assistance of a surgical robot. This allows your surgeon to operate using very small incisions and specialized instruments.”

During surgery, the stomach is moved back into the abdomen and the opening in the diaphragm is tightened. In many cases, a procedure called a fundoplication is done to strengthen the valve between the esophagus and stomach. Most patients stay in the hospital overnight and go home the next day.

We’re Here to Help You Heal Your Hiatal Hernia

Your health matters. Our team at AdventHealth is dedicated to listening to your concerns, offering a quick and accurate diagnosis and providing leading-edge treatment options that help get you back to living your best life.

To learn more about hiatal hernias and to schedule an appointment with Dr. Ramlogan, click here. You deserve to feel whole.