The normal location of the stomach is in the abdominal region. The esophagus enters the abdominal wall through an opening in the diaphragm muscle and connects to the stomach. The protrusion of the stomach upwards through the opening in the diaphragm muscle where the esophagus exits is called a hiatal hernia.
What are the symptoms?
Patients with hiatal hernia also experience reflux symptoms because the valve mechanism at the entrance to the stomach is disrupted. In other words, the cause of 40-50% of gastric reflux is hiatal hernia. Acid reflux, which occurs together with a hiatal hernia, may be behind burning, pain in the chest, bitter water coming to the mouth, chronic pharyngitis of unknown cause in the throat, hoarseness, lung diseases such as chronic asthma and bronchitis, the cause of which cannot be found. At the same time, early satiety and a feeling of fullness in the abdomen may occur with or without reflux symptoms. In some people, it occurs with an acute onset of symptoms due to reasons such as stomach perforation, stomach compression, and disruption of gastric blood flow, causing them to go to the emergency room. This condition can cause sudden onset of chest pain, mimicking a heart attack.
Why does a hiatal hernia occur?
There are many causes of hiatal hernia. The most important of these is familial predisposition. A wide opening in the diaphragm muscle and a weak diaphragm muscle may cause a hiatal hernia. Some conditions play a role in the formation of hiatal hernia. Diseases that increase abdominal pressure such as obesity, chronic cough, and constipation are some of these. Diabetes can also contribute to the development of hiatal hernia by delaying gastric emptying and increasing the pressure in the stomach.
What causes if left untreated?
If a hiatal hernia is left untreated, it may cause wounds, stenosis in the esophagus, bleeding and ulcers due to exposure to stomach acid due to reflux in the esophagus. It can also cause ulcers in the stomach and, at more advanced levels, bleeding and full-thickness ruptures in the stomach, which we call gastric perforation. Sometimes the stomach can get stuck in this opening in the diaphragm, disrupting its blood supply and causing serious damage. In such serious situations, emergency surgery may be inevitable.
What should be done to diagnose hiatal hernia?
A full stomach after meals. If there are symptoms such as engorgement, bloating, burning in the chest, pain, bitter water in the mouth, sudden burning in the throat, especially when lying down, and cough, the inside of the stomach along with the esophagus should be evaluated with endoscopy. The first step in the diagnosis of hiatal hernia and reflux is endoscopic examination. If necessary, Computed Tomography is also an auxiliary examination to determine the degree of hiatal hernia after endoscopy.
What are the treatment methods for hiatal hernia?
The only treatment for hiatal hernia is surgery. The aim is to pull the displaced, that is, herniated, part of the stomach upwards from the opening in the diaphragm muscle to its normal place, to narrow this gap and to prevent the stomach from herniating again. If there is only an enlargement of the diaphragm without a hernia, symptoms may regress with medication and changing eating habits to reduce stomach pressure. However, if the stomach is above the diaphragm opening, this opening must be repaired with surgery and the stomach must be brought to its normal position.
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