Types of Hiatal Hernia

Different types of hiatus hernia.

Green is the esophagus, red is the stomach, purple is the diaphragm, blue is the HIS-angle.

A is normal; B is pre-stage; C is a sliding hernia; D is a paraesophageal hernia.

As you know, a hiatal or hiatus hernia is the protrusion of part of the stomach through the diaphragm into the chest cavity. It occurs when small part of the stomach moves up through the diaphragm because the opening through which the esophagus passes is somehow either in large all the muscles of the diaphragm have become weaker. You may never know that you have a hiatal hernia, but it can cause problems by allowing acid and food from the stomach contents to move backwards up into the esophagus. Generally speaking, only a very large hiatal hernia will require surgery.

Having said that, there two types of hernia, one of which is considerably more serious than the other. 95% of these hernias are of the sliding type, where the portion of the stomach protruding through the diaphragm is free to move upwards and downwards. The gastroesophageal junction has moved up above the diaphragm, but can still move backwards and forwards freely. In a paraesophageal hiatus hernia, part of the stomach is trapped above the diaphragm alongside the esophagus without any free movement.

The good news about having a hiatal hernia is that most people who have the condition will not experience any signs or symptoms. And of course an asymptomatic hiatal hernia doesn’t really require any treatment – indeed, you probably won’t get any treatment because you won’t know you have a problem in the first place!

Even when there are signs that a hernia is present, treatment for a hiatal hernia is really about treatment for the symptoms that you experience; these may include acid reflux, heartburn, and possibly gastroesophageal reflux disease or GERD.

Hiatal hernia is actually nicknamed the great mimic because of its capacity to mimic the symptoms of so many other conditions. These include palpitations, shortness of breath, discomfort in the esophagus, acid reflux, indigestion and heartburn.

Heartburn, indigestion and acid reflux are terms that are commonly confused, so let’s try and establish exactly what they are before we go any further. But first, a small diversion….

Acid reflux is the movement of stomach contents up into the esophagus; it causes heartburn, which is basically a burning sensation inside the chest. Indigestion, by contrast, is a term is used to describe discomfort or fullness during or after eating, perhaps with a sense of burning or pain in part of the stomach. The not entirely separate, but they diagnosed more or less by the area of which they occur; indigestion implies a stomach problem, either a bloated, full feeling, a sense of nausea, a growling stomach, pain in the abdomen, or perhaps a burning sensation in the stomach.

Hiatal Hernia Treatment

Clearly, you’re going to want to treat any symptoms of heartburn or indigestion. This could be done with over-the-counter antacids products such as Maalox, Rennies and Tums. This might provide superficial and symptomatic relief, but it’s much more likely that you’re going to need something to reduce acid production.

Medications like Tagamet and Zantac (ranitidine and cemetidine respectively) have proved immensely effective over the years in reducing the production of stomach acid; they’re now available over-the-counter, with stronger versions available by prescription.

However, to some extent they’ve been superseded by proton pump inhibitors or PPIs which actually block acid production. These medications include Prevacid and Prilosec (lansoprazole and omeprazole respectively). The advantage of taking these medications is that they allow damaged esophageal tissue to heal.

In a rather limited number of cases surgery may be required for hiatal hernia treatment. There are various approaches to this, the most common of which is the Nissen fundoplication. In this operation, the upper part of the stomach is wrapped around the lower part of the esophagus, thereby preventing the stomach protruding through the hiatus in the diaphragm – and coincidentally inhibiting the reflux of gastric juices and acid. This is a medical procedure that is generally conducted laparoscopically, and has a high success rate, with quick recovery times.

Diagram from Wikipedia commons.