Hiatal Hernia


Lyall Gorenstein Giant Hiatal Hernia Audio: Giant Hiatal Hernia
Lyall A. Gorenstein, MD
6:57 min
Listen to Giant Hiatal Hernia

In a hiatal, or hiatus hernia, a portion of the stomach penetrates (herniates) through a weakness or tear in the hiatus of the diaphragm, the small opening that allows the esophagus to pass from the neck and chest to its connection with the stomach. Often there are no symptoms, and the condition may not cause any problems. The patient may not be aware they have a hiatal hernia.

Sliding Hiatal Hernia

Stages of Hiatal Hernia
— esophagus
— diaphragm
— stomach
— angle of fundus (upper stomach)

The term sliding is employed when hiatal hernia involves the lower esophageal sphincter where the esophagus attaches to the stomach. It can also involve a small portion of the stomach. The patient may experience heartburn and gastroesophageal reflux. Because reflux may damage the lining of the esophagus, treatment is essential. Symptoms can usually be managed with medications and behavior modification such as elevating the upper body on a pillow during sleep. Surgery may sometimes required to correct a sliding esophageal hernia.

Paraesophageal Hernia and Intrathoracic Stomach

In more severe cases of hiatal hernia, the fundus, or upper portion of the stomach may slide upward into the chest cavity through the hiatus. The condition occurs as an intensifying of a sliding hiatal hernia. In rare cases, the entire stomach and even some of intestines may migrate through the hiatus and rest on top of the diaphragm next to the esophagus, a condition known as giant esophageal hernia.

Symptoms of parasophageal hernia may include problems swallowing, fainting, and vomiting.

Risk Factors for Hiatal Hernia

Hiatal hernia is initiated by pressure in the abdomen occurring through:

  • Heavy lifting
  • Hard coughing or sneezing
  • Violent vomiting
  • Pregnancy and delivery
  • Obesity may also cause hiatal hernia because of pressure on the abdomen
    caused by extra weight.
  • Heredity
  • Smoking
  • Stress
  • Short esophagus (paraseophageal hernia)

Hiatal hernia is diagnosed with an upper GI series or endoscopy.

Columbia University Medical Center       New York Presbyterian Hospital
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