Hiatus hernia: types, symptoms, causes and treatment

Our digestive system is one of the most important parts of our body because it allows us to get the nutrients we need to survive. One of the main organs in this system is the stomach, being the first of the digestive organs located completely inside the abdomen.

To do this, food must pass through the esophagus, which must pass through the diaphragm through an opening called the esophageal hiatus. However, in some cases problems arise like the hiatus hernia, in which part of the stomach goes through this opening and causes different problems and pains.

    Hiatus hernia: main concept and symptoms

    As we mentioned, the esophageal hiatus is a small hole in the diaphragm that allows the esophagus to pass through and reach the stomach, located under the diaphragm. Under normal conditions, it is the esophagus that runs through it, separating the diaphragm from the thoracic and abdominal organs. However, sometimes a problem arises called a hiatus hernia.

    Hiatus hernia or hiatus hernia is a medical condition in which part of the stomach protrudes through the esophageal hiatus, Leaving part of it in the chest. This is a relatively common problem that can lead to different symptoms, although it can also occur asymptomatically. This medical condition is generally more common in people between the ages of forty and sixty, although it can appear at other ages as well.

    In cases where symptoms appear it is common for discomfort or a burning sensation to occur which can reach the throat known as heartburn, pain, dysphagia or difficulty swallowing, possible regurgitation of food, and gastroesophageal reflux disease. Breathing difficulties and obstructions may appear in the esophagus.

    Although in many cases it is a benign thing that may not even cause symptoms, hiatus hernia it can become dangerous if left untreated, Because some complications may arise. These complications can be gastric perforation, death of digestive tract tissue due to necrosis, respiratory complications, or even the lungs absorbing part of the stomach contents. Sometimes bleeding also occurs, visible in black or red stools or bloody vomit, it is also concerning.

    Finally, there may be a weakening of the walls of the esophagus and stomach which can result in an esophageal cap, a condition that can increase the risk of cancer.

      Types of hiatus hernia

      They were made various classifications with respect to the different subtypes of hiatus hernia, Observation of different types.

      1. Slippery or sliding hernias

      This is the most common type of hiatus hernia. This subtype is characterized by the gastroesophageal junction (the part where the esophagus and the stomach meet) and a part of the stomach called the cardia (the upper part and connected to this junction). they protrude and pass through the diaphragm, being located in the thorax, Because the ligament that must hold the gastroesophageal junction in place is not strong enough.

      2. Parasophageal or rolling hernia

      In this subtype of hiatus hernia, part of the stomach that is not the cardia protrudes through the hiatus, which is usually larger in size than usual. The cardia and gastroesophageal junction are in place, but are part of the upper stomach protrudes through the hiatus forming as a small bump parallel to the esophagus.

      3. Mixed hiatus hernia

      This subtype of hiatus hernia involves the union of the characteristics of the above two.

      4. Type 4 hernia

      This type of hernia appears when it is another viscera that exceeds through the hiatus, such as the colon or spleen. They may or may not be accompanied by the stomach.

      5. Inverted stomach

      This condition is rare and extreme and can cause serious health problems. In this one, the whole stomach is in the chest.

      Causes of hiatus hernia

      The reason why part of the stomach protrudes from the hiatus can vary widely. In some cases, it is possible to find that there are birth defects or conditions that cause or facilitate it (For example, some people have a much bigger gap than usual).

      However, this type of problem is generally considered to have an acquired cause. One possible explanation is the loss of flexibility and strength of the ligaments and musculature of the diaphragm with age.

      Another possible cause is found in the excessive strain on the abdominal muscles or the diaphragm itself. For example, people with digestive problems who have to exert great efforts to defecate or people with persistent, strong and chronic coughs can even cause movement and protrusion of the stomach.

      Performing some surgeries can also cause the hiatus to extend. The same can happen with obesity or pregnancy. if the pressure in the abdominal muscles increases.


      The treatment to be applied in each case of hiatus hernia will largely depend on the situation of each individual. In case of gastroesophageal reflux disease (a disorder with which comorbidity is common), this condition should also be treated.

      In some cases, treatment may not be necessary, although it is advisable to follow a diet that includes low-fat meals that avoid fried foods, fats, spices, alcohol, and products that increase fat. acidity or gas in the body. low-fat meals; and pH-regulating products, such as yogurt and certain types of dairy products.

      Some people need different types of medicine such as antacids to reduce stomach acidity, histamine-2 inhibitors or proton pump inhibitors.

      In the most serious cases surgery may be necessary to move affected organs at the same time, the hiatus is reconstructed and measures are created to regulate intra-abdominal pressure.

      Bibliographical references:

      • Pérez, JJ; Viscarra, JF; and Rivers, CG (2017). Hiatus hernia: a diagnostic and therapeutic challenge. About a case. Medical Screws, 30 (2): 83-88.
      • García, M. and Duménigo, O. (2002). Mixed hiatus hernia. Report a case. Cuban Journal of Surgery, 41 (2). City of Havana.

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