HIATAL HERNIA

RMacLean
January 2007

WHAT IS HIATAL HERNIA?

A hernia occurs when part of an organ (usually the intestines) protrudes through a weak point or tear in the thin muscular wall that holds the abdominal organs in place.  There are several different types of hernias, but a hiatal hernia is frequently associated with gastroesophageal reflux. A hiatal hernia occurs when the stomach protrudes through a small opening in the diaphragm (diaphragmatic hiatus) -- called also hiatus hernia Some doctors believe a hiatal hernia can weaken the LES and thus cause reflux. If the lower esophageal sphincter slides up above the diaphragm, it may not close well, and stomach acid and juices may back up into the esophagus (acid reflux).

Recent studies suggest that the opening in the diaphragm acts as an additional sphincter around the esophagus. It's also been shown that hiatal hernia results in the retention of acid and other contents above this opening. These substances are then able to reflux easily into the esophagus.

WHAT ARE THE SYMPTOMS OF HIATAL HERNIA?

A hiatal hernia by itself rarely causes symptoms -- pain and discomfort are usually due to the reflux of gastric acid, air, or bile. Reflux happens more easily in the presence of hiatal hernia, though a hiatal hernia is not the only cause of reflux. It often is only diagnosed when the child is being evaluated for reflux or GERD.  Other symptoms might be difficulty swallowing, chest pain or belching.

WHAT CAUSES HIATAL HERNIA?

Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Though, children with this condition usually have it from birth (congenital). Obesity can also contribute to hiatal hernia.

HOW IS HIATAL HERNIA DIAGNOSED?

An upper GI or an scope can show if hiatal hernia is present.

HOW IS HIATAL HERNIA TREATED?

Hiatal hernias usually will not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply, i.e. paraesophageal hernia) or is complicated by severe GERD or esophagitis (inflammation of the esophagus). In these cases, surgery may be required to reduce the size of the hernia or to prevent strangulation.