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Hiatal hernia - symptoms and detection

Hiatal hernia (or diaphragmatic hernia) is a common condition acquired during life, which in half of all cases may develop asymptomatically.

To understand how this type of hernia develops, it's important to know that the anatomy of the digestive system is such that the lower portion of the esophagus passes through an opening in the diaphragm into the upper (cardiac) portion of the stomach. The diaphragm separates the thoracic cavity from the abdominal cavity, and this opening in the diaphragm is tightly and hermetically sealed with connective tissue (the so-called membrane) to prevent the two cavities from communicating. However, under certain conditions, the membrane can stretch significantly, allowing the portion of the esophagus located in the lower cavity to rise and exit through the diaphragmatic opening.

Factors that contribute to the development of hiatal hernia include:

weak ligamentous apparatus, too elastic, which allows the connective tissue to stretch excessively;
excessively increased intra-abdominal pressure, which is most often observed in people with a chronic, intense cough;
Elevation of the esophagus due to esophageal diseases (for example, esophageal dyskinesia, which usually accompanies conditions such as gastric ulcers, duodenal ulcers, chronic liver and pancreatic diseases, reflux esophagitis, and other conditions). Not only the esophagus, but also the upper stomach and, in special cases, intestinal loops, can be pulled upward and pass through the diaphragmatic opening;
The gag reflex and hiccups can also provoke excessive stretching of the diaphragmatic opening membrane.

The pain associated with a hiatal hernia resembles chest pain similar to angina or heart pain, which can lead to misdiagnosis by a cardiologist (diaphragmatic hernias, like heart disease, are often diagnosed in older adults). A characteristic feature of diaphragmatic hernia pain is its increased intensity when bending forward.

Another symptom of a hiatal hernia is belching after eating or at night, when acid rises (splashes) into the esophagus and oral cavity.

A symptom of a hiatal hernia may be difficulty passing food through the esophagus, but this symptom may not be constant.

Pain behind the breastbone when food passes through the esophagus can be considered a symptom of hiatal hernia.

A strangulated hiatal hernia is one of its most serious complications. This type of strangulation can be accompanied by cramping pain in the left hypochondrium and epigastrium (relieved by turning the body onto the left side), shortness of breath, nausea, and vomiting.

A hiatal hernia is detected by chance during diagnosis in half of the cases, for example, during radiography, esophagoscopy, gastroscopy, or endoscopic examination of the esophagus or stomach.