Diaphragmatic hernia: what it is, types and signs of esophageal hernia

You have read in the report "hiatal hernia" and want to understand what it means. I explain step by step: what moves, what types exist and what the examination shows. For many people this is not an emergency but a condition that they live with and that is monitored.

Diaphragmatic hernia: what it is

The diaphragm is the muscle that separates the chest from the abdomen. It has an opening for the esophagus; it is called the hiatus. Normally the esophagus passes through this opening and the stomach remains below the diaphragm. In a hernia, the upper part of the stomach protrudes through the opening into the chest. The diaphragm helps keep acid in the stomach. When a hernia appears, acid can more easily rise into the esophagus. This reflux of acid from the stomach into the esophagus is called GERD — gastroesophageal reflux disease.

Hiatal hernia belongs to the group of diaphragmatic hernias. It is very common in people over 50. If there are no complaints, treatment is usually not required.

Types: sliding, paraesophageal and mixed

The classification distinguishes sliding hernias (traction, pulsion and mixed), paraesophageal and mixed. The names in the report may vary; if the wording is unclear, clarify it with your doctor. In a paraesophageal hernia, part of the stomach moves into the chest next to the esophagus.

According to the level of elevation above the diaphragm and volume, cardiac, cardiofundal, subtotal and total gastric hernias are distinguished. In everyday speech people sometimes say "hernia in the stomach" or "gastric hernia". A more accurate statement is different: it is the stomach itself that moves through the opening in the diaphragm, not a hernia inside the stomach.

Why esophageal hernia occurs

The cause is often unknown: muscle weakness, trauma, and a congenital defect are discussed. The risk is higher after age 50, with obesity, smoking, and pregnancy.

Predisposing factors include obesity, frequent constipation, persistent cough, smoking and heredity.

Signs and pain in esophageal hernia

Small hernias rarely cause discomfort. When complaints are present, they are usually symptoms of GERD: burning pain in the chest after eating (heartburn), regurgitation of small portions of food or bitter fluid, bad breath, bloating, nausea and vomiting, difficulty or pain when swallowing.

Heartburn in esophageal hernia often occurs at night — due to relaxation of the lower esophageal sphincter — and after eating, with a sudden change in body position. Pain in esophageal hernia is burning or dull, radiates to the heart area, shoulder blades, left shoulder, and worsens with bending and physical exertion. Discomfort behind the sternum, weight loss, hoarseness, attacks of coughing and suffocation during sleep are added.

How diaphragmatic hernia is detected

Usually the hernia is found during examination for GERD, heartburn, chest or abdominal pain. The methods are as follows:

• chest X-ray;
• X-ray with barium contrast (barium swallow);
• esophagogastroduodenoscopy — examination of the esophagus and stomach from the inside;
• CT of the chest and mediastinum, if the size and extent of the hernia need to be clarified.

Ask your doctor which examinations you specifically need.

Possible complications and when a doctor is needed

With a hernia, acid can more easily rise into the esophagus — this is GERD, which can cause heartburn, difficulty swallowing, dry cough, breathing problems, and destruction of tooth enamel.

See a doctor if symptoms do not resolve within 3 weeks, are severe or worsening, and pharmacy remedies do not help. Without waiting — if weight decreases without effort, swallowing becomes difficult, vomiting is frequent, blood appears in vomit, or the upper abdomen hurts. When complaints are severe and the prescribed treatment does not help, surgery is discussed. Usually this is laparoscopy under general anesthesia: small incisions on the abdomen. After surgery, it takes up to 6 weeks to return to usual eating, and several months for bloating, flatulence and difficulty swallowing. Sometimes a repeat operation is needed.

Hiatal hernia by itself is not a reason to call an ambulance. 103 or 112 are needed if blood appears in vomit or if swallowing is impossible together with frequent vomiting.

This is reference material, not a consultation: discuss your own report and complaints with a doctor.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer