Five facts you should know about hiatal hernias

As a medical professional and board-certified thoracic surgeon, I understand there is lot of information out there about common medical conditions that individuals deal with on a daily basis – including hiatal hernias.

A hiatal hernia occurs when part of the stomach pushes up into the diaphragm through an opening called the esophageal hiatus, through which the esophagus travels to bring food to the stomach. Most of the time, symptoms of reflux from hiatal hernias may be treatable with medication. Some require surgery.

Since it’s not always easy to find and identify what is relevant and reliable information about this condition, here are five facts you should know.

Fact 1: Hiatal hernias, especially smaller ones, are relatively common. Statistics reveal that 60% of adults will have some degree of a hiatal hernia by age 60, and even these numbers do not reflect the real prevalence of the condition because many hiatal hernias can be asymptomatic. You could be walking around with a hiatal hernia and not know it.

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For some people, the hernia will never cause any problems. For others, it can cause painful symptoms over time, and the individual will need to seek medical treatment.

Fact 2: Symptoms of hiatal hernias can be variable, ranging from nothing unusual to trouble swallowing and reflux disease. Sometimes, people with a hiatal hernia may find themselves gravitating towards smaller meals and feeling full very quickly. Other times, people experience shortness of breath or discomfort/pain around the diaphragm and into the belly.

Hiatal hernias often mask as different conditions. Sometimes, people with large hiatal hernias present with very low iron levels (anemia). The underlying cause for this is thought to be small erosions at the base of the hernia that cause a leakage of blood, although there are other factors as well. Hiatal hernias also mask as heart problems and many will go see a doctor complaining of chest pain and severe heartburn.

Fact 3: There is a genetic factor. As a thoracic surgeon who has operated on many patients with hiatal hernias, I can tell you that a person can be predisposed to getting hernias in general, including hiatal hernias. The reason for this is that hernias are more likely to occur in people with looser connective tissues or an unusually large hiatus.

If a parent has this type of tissue, their children often do as well. Lifestyle factors like obesity, smoking, and age can increase the chance that a hernia will form. Some hernias can take several years to develop.

Fact 4: Hiatal hernias can be treated with minimally invasive surgery using tiny incisions, resulting in less blood loss and scarring, leading to an easier, faster recovery. Minimally invasive surgery performed for a hiatal hernia can reduce the likelihood of later complications such as an abdominal wall hernia, which can form when longer, open incisions are used. However, if the hernia is large, with multiple organs affected, then an open surgery might be necessary.

Fact 5: Your surgeon matters. Go to an experienced surgeon and surgery center to get the best hiatal hernia repair. He or she will know certain techniques that can help prevent recurrence of the hiatal hernia and/or the likelihood of the formation of an abdominal wall hernia.

Most of the time, hiatal hernias are not considered a medical emergency. However, if the hernia becomes strangulated, meaning there is a lack of blood flow to tissue that has moved up through the diaphragm, then it is imperative that it be corrected immediately to prevent necrosis (tissue death) or perforation of the stomach (a hole in the stomach tissue).

Additional Resources

Learn more about the Division of General Thoracic Surgery at Baylor College of Medicine.

See more information about hiatal hernias.

-By Dr. Philip Carrott, assistant professor of surgery in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine

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