Hiatal (Hiatus) Hernia

What Is a Hiatal Hernia?

A hiatal or hiatus hernia occurs when part of the stomach pushes upward through an opening in the diaphragm and into the chest cavity. This abnormal positioning can lead to heartburn, acid reflux, and chest discomfort.

What Are the Types of Hiatal Hernias?

There are two main types of hiatal hernias, each with distinct characteristics:

• Sliding Hiatal Hernia

  – This is the most common type, where the stomach and the lower part of the oesophagus slide up into the chest through the hiatus. It often leads to symptoms like heartburn and acid reflux due to the displacement of the gastroesophageal junction.

• Paraesophageal Hiatal Hernia

  – In this less common but potentially more serious type, part of the stomach pushes through the diaphragm and sits next to the oesophagus. This can cause complications such as strangulation of the stomach tissue, which requires prompt medical attention.

What Are the Risk Factors for Hiatal Hernias?

Certain individuals are more predisposed to developing a hiatal hernia due to specific risk factors:

• People Age 50 and Above – Individuals over 50 are more likely to develop hiatal hernias due to age-related weakening of the diaphragm and supporting tissues.
• Obesity – Excess weight can put pressure on the abdomen, increasing the risk of the stomach protruding through the diaphragm.

What Are the Symptoms of Hiatal Hernias?

Hiatal hernias can present a range of symptoms, often related to the displacement of the stomach and its impact on the oesophagus. These include:

• Heartburn – A burning sensation in the chest, often caused by acid reflux.
• Chest Pain – Discomfort or pain in the chest, which can be mistaken for heart problems.
• Indigestion – General discomfort, including bloating, burping, and nausea.
• Difficulty Swallowing – A feeling of food being stuck in the throat or chest.
• Sore Throat – Persistent irritation or a chronic sore throat, often due to acid reflux.

How Is a Hiatal Hernia Diagnosed?

On top of a physical exam, diagnosing a hiatal hernia involves several medical tests and procedures to confirm the condition and assess its severity:

• Chest X-ray

  – A standard chest X-ray can sometimes detect abnormalities in the diaphragm and stomach area, indicating a potential hiatal hernia. This is often used as an initial diagnostic tool.

• Barium Swallow

  – In this test, the patient drinks a barium solution, which coats the oesophagus and stomach. X-rays are then taken to provide clear images of the upper digestive tract, revealing the presence of a hernia.

• Upper Endoscopy

  – During an upper endoscopy, a thin, flexible tube with a camera (endoscope) is inserted through the mouth into the oesophagus and stomach. This allows direct visualisation of the hernia and any associated inflammation or damage to the oesophagus.

• Oesophageal Manometry

  – This test measures the oesophagus's rhythmic muscle contractions (peristalsis) when swallowing. It also assesses the function of the lower oesophageal sphincter and the pressure within the oesophagus, helping to identify issues related to a hiatal hernia.

Hiatal Hernia Treatments in Singapore

Your doctor may recommend medication or surgery to treat hiatal hernia.

Medications

These medications do not directly treat the hernia. Instead, they focus on alleviating its symptoms and associated effects, such as heartburn.

• Antacids

  – These neutralise stomach acid and provide quick relief from heartburn.

• H2-Receptor Blockers

  – These medications reduce acid production and provide longer-lasting relief than antacids.

• Proton Pump Inhibitors (PPIs)

  – PPIs are highly effective in reducing stomach acid production and healing the oesophagus from damage caused by acid reflux.

Surgery

Surgery may be considered if lifestyle changes and medications are insufficient or if complications arise. The goal of surgery is usually to repair the hernia and prevent acid reflux.

• Open Repair

  – This traditional method involves a large incision in the abdomen or chest to access and repair the hernia.

• Laparoscopic or Robotic Repair

  – These are minimally invasive procedures use small incisions. In Laparoscopic repair involves a camera-guided tool, while robotic repair offers enhanced precision via a surgeon-controlled robot. Both methods generally result in faster recovery times and less postoperative pain.