If you experience heartburn, gastroesophageal reflux, and difficulty swallowing food, they could be symptoms of a hiatal hernia. Hiatal hernia involves the migration of a part of the stomach into the chest. It is caused by a relaxation of the walls of the hiatus, which is the area in the diaphragm that allows the passage of the esophagus. Hiatal hernia is very common in the general population. It can be asymptomatic or associated with symptoms like the ones mentioned above.

Sliding, Paraesophageal, and Mixed Hiatal Hernia

When we talk about hiatal hernia, it is essential to distinguish it based on its symptoms. 

The form of hiatal hernia that develops in most cases is the sliding form, which involves the migration of a part of the stomach into the chest due to the pressure from the abdomen. This type of hernia is common in patients with abdominal obesity, and symptoms occur mainly when the patient is lying flat on the back.

Paraesophageal hernia, on the other hand, appears when the upper part of the stomach goes into the thoracic cavity alongside the esophagus.

Lastly, the mixed hernia is an uncommon disorder in which both the sliding hernia and paraesophageal hernia occur simultaneously.

What Are the Symptoms of Hiatal Hernia?

A hiatal hernia may occur without having any specific symptomatology. If symptomatic, typical manifestations involve symptoms of gastroesophageal reflux disease, a disorder that is relatively easily recognized because it causes burning, regurgitation, and pain in the area behind the sternum due to rising stomach acid from the stomach to the esophagus. 

Other symptoms of hiatal hernia include: 

  • Heart palpitations after meals
  • Halitosis
  • Nausea
  • Dysphagia (difficulty swallowing food)

Hiatal Hernia: The Gastroenterological Examination and Tests for its Diagnosis

When the symptomatology is mild, it can be resolved with the therapy prescribed by a physician or a gastroenterologist. 

If the symptomatology is not successfully controlled with medication or the symptoms are more severe (slimming, vomiting, acute pain in the upper abdomen), a gastroenterologist should be consulted promptly. The expert will indicate the necessary follow-up examinations, such as esophagogastroduodenoscopy and x-ray of the esophagus, and prescribe the appropriate type of treatment.

Familiarity or Trauma: The Risk Factors for Hiatal Hernia

As already mentioned, a hiatal hernia is caused by the loosening of the hiatus. This is a condition that congenital factors can bring about, but it can also be caused by age, overweight, obesity, or pregnancy. 

Other risk factors include:

  • Trauma in the abdominal area;
  • Strong abdominal muscle pressure resulting from defecation;
  • Episodes of coughing and vomiting;
  • Physical activities, such as using arm weights at the gym.

Hiatal Hernia: What to Eat and What to Avoid?

When asymptomatic, a hiatal hernia does not need to be treated – e.g., in cases of mild symptoms that can be traced to gastroesophageal reflux – it is, first and foremost, necessary to change one’s diet. 

Foods that can worsen symptoms include:

  • Spicy, fried, and high-fat foods, such as sausages, some cheeses, sauces, and butter 
  • Tomatoes
  • Citrus fruits
  • Mint
  • Chocolate
  • Coffee
  • Tea
  • Alcohol

Meals should be small and frequent, eaten long before bedtime, and lying down should be avoided in the hour following the meal. If watching television, it is better to do so while sitting in a chair, for example.

In addition, those who suffer from hiatal hernia should quit smoking and, if overweight or obese, start a weight-loss program with the help of a nutritionist, as both conditions can cause the problem.

How is Hiatal Hernia Treated?

When the symptoms of hiatal hernia are more severe, drug therapy may be necessary. This may include over-the-counter medications such as antacids and alginates or prescription drugs such as proton pump inhibitors and H2 antagonists.

In more severe cases, the specialist may consider surgical treatment performed under general anesthesia and laparoscopically – small holes are created in the abdomen, leaving almost invisible scars and allowing the patient a faster recovery. Laparoscopic hiatal hernia treatment usually requires three days at the hospital and 3-6 weeks of recovery.