It is estimated that up to 20% of the population may suffer from a hiatal hernia. Although the vast majority will not experience symptoms, the rest may experience burning, chest pain, or difficulty swallowing. The best thing is to learn to prevent it.

The stomach is located in the abdominal cavity. It is separated from the thorax by a muscle called the diaphragm, which plays a very important role in breathing since it is responsible for helping the expansion/contraction of the lungs.

In the diaphragm, a small opening called the hiatus, through which the esophagus enters, becomes, once the diaphragm has passed, into the stomach. Thus, it could be said that the natural anatomical location of the stomach is once “past” the diaphragm.

What is hiatal hernia?

A hiatal hernia results from a part of the stomach rising through the diaphragmatic hiatus to the chest. Although there are several types, the most common is sliding hernia (95% of cases), in which both the gastroesophageal junction and a portion of the upper stomach slide through the hiatus. Other less frequent types are paraesophageal hernias, in which the fundus of the stomach is located in the thoracic cavity through the hiatus, being parallel to the esophagus. In some cases, other abdominal viscera could even pass through this opening.

Hiatal hernia can affect people of any age due to a congenital disability of the hiatus itself (congenital diaphragmatic hernia). Still, this disorder’s frequency of appearance increases after 50 years of age, especially in the elderly.

It is a very common pathology, but as it does not always produce symptoms, its prevalence is not exact, varying greatly depending on the population studied.

Causes of hiatal hernia

The diaphragm can be found weakened by a large number of conditions, pathologies, or circumstances. To the genetic factors already mentioned, the following causes of hiatal hernia can be added :

  • Aging: As we age, the diaphragmatic muscle can become somewhat weaker, allowing the stomach to protrude. This explains its high incidence as we age due to the loss of tone of the ligaments surrounding the esophageal hiatus and the weakness of the diaphragmatic musculature.
  • Chronic cough: due to the constant effort that coughing supposes for the thoracic cavity (let’s not forget that the diaphragm is closely related to the lungs).
  • Constipation: people prone to constipation make continuous efforts when defecating, and this pressure in the abdominal cavity can affect the sliding of the upper part of the stomach.
  • Obesity: An increase in abdominal volume can pressure the abdominal organs, the stomach between them, and force the passage through the hiatus. In general, any circumstance that chronically and repeatedly increases intra-abdominal pressure can lead to a hiatal hernia. It also happens in the events such as pregnancy.
  • Lifting very heavy objects.
  • Smoking: tobacco use seems to be associated with the appearance of a hiatal hernia. Both tobacco and alcohol can also promote reflux symptoms associated with hernia due to their action on the esophageal sphincter, relaxing it abnormally.
  • Surgeries: stomach and some esophageal operations can damage the diaphragm and help weaken or enlarge the hiatal area. This fact is more related to paraesophageal hernias.

Symptoms of hiatal hernia

The hiatal hernia does not always produce symptoms, but more than half of gastroesophageal reflux cases exist in a hiatal hernia. The symptoms result from the regurgitation of the stomach contents into the esophagus, producing a more or less serious irritation of the mucosa of the esophagus by gastric acid. This happens because the dam or containment function is lost due to the action of the hiatus itself and its membranes, and the lower esophageal sphincter. There is, therefore, a direct relationship between the size of the hernia and the intensity of the discomfort.

When there is gastroesophageal reflux, the following symptoms of a hiatal hernia may appear :

  • Burning (heartburn): the acid content irritates the lining of the esophagus, causing discomfort in the stomach’s pit.
  • Chest pain: if this burning sensation reaches high areas of the esophagus, the pain may be felt more in the thoracic area than in the abdominal area, confused with a more alarming pain, for example, that of myocardial infarction.
  • Difficulty swallowing: The esophagus walls’ irritation can trigger a discomforting sensation when swallowing solid food, either at a low level ( dysphagia ) or even in the pharyngeal area (odynophagia).
  • Regurgitation and belching: a bad taste in the mouth may appear, bad breath due to the content that refluxes into the mouth, and the appearance of belching after meals.
  • Cough: occurs when lying down after meals due to the rise in gastric content and the larynx’s irritation.
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