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A hiatal hernia occurs when part of the stomach pushes up through an opening in the diaphragm into the chest cavity.
The diaphragm is a muscle that separates the abdomen from the chest, and it normally keeps the stomach below it. This condition can cause discomfort and digestive issues, such as acid reflux or heartburn, and is more common in adults over 50.
Hiatal hernias cause a variety of symptoms due to the displacement of the stomach into the chest cavity, affecting how the digestive system functions:
Heartburn: When the stomach pushes through the diaphragm, it weakens the barrier that normally prevents stomach acid from entering the oesophagus. Heartburn occurs when stomach acid flows back into the oesophagus, a condition known as acid reflux.
Difficulty Swallowing: The hernia can put pressure on the oesophagus or cause it to become compressed, making it difficult for food to pass smoothly from the throat to the stomach.
Chest Pain or Discomfort: The stomach’s abnormal positioning can press against surrounding organs, leading to discomfort or pain, especially after meals when the stomach is full.
Belching or Bloating: The disruption in stomach positioning may cause food and gas to become trapped, resulting in excess gas build-up. This can lead to frequent burping, a sense of fullness, and bloating, particularly after eating.
Hiatal hernias occur when the diaphragm muscles surrounding the opening weaken, allowing the stomach to move upwards into the chest. Common contributing factors include:
Muscle tissues throughout the body, including the diaphragm, weaken with age, making it easier for the stomach to push through the diaphragm.
Activities like heavy lifting, chronic coughing, or straining (e.g., during bowel movements) increase pressure in the abdomen, potentially pushing the stomach through the diaphragm opening.
Excess weight around the abdomen puts additional pressure on the stomach and diaphragm, increasing the likelihood of the stomach slipping into the chest cavity.
Some people may inherit weaker diaphragm muscles or anatomical differences that increase the likelihood of hernias, implying that family history is a significant factor in the development of this condition.
Diagnosing a hiatal hernia involves several steps to accurately confirm its presence and determine the most appropriate treatment plan.
The doctor will enquire about symptoms such as heartburn, chest pain, or swallowing difficulties. They may assess for acid reflux, especially after meals, to determine if a hernia is present. However, because these symptoms can resemble those of other conditions, a physical examination alone is often not enough to confirm the diagnosis, and further testing is usually required.
X-rays: These are used to visualise the position of the stomach and diaphragm, helping to identify if the stomach has moved up through the diaphragm.
Barium Swallow Test: In this procedure, the patient drinks a contrast liquid (barium) that coats the digestive tract. This makes the oesophagus and stomach visible on X-ray images, highlighting any abnormal movement or structural changes.
Endoscopy, or gastroscopy, involves inserting a thin, flexible tube with a small camera down the throat to directly observe the oesophagus and stomach. This procedure is useful for identifying a hiatal hernia, assessing the severity of the condition, and detecting signs of inflammation or damage from acid reflux. It can also help rule out other conditions with similar symptoms and detect structural abnormalities.
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Treatment depends on the hernia’s size, symptom severity, and the patient’s overall health. Non-surgical methods may suffice for mild cases, while surgery is needed for complications or persistent symptoms.
Medications help manage symptoms by reducing stomach acid but do not treat the hernia itself. Antacids provide quick but short-term relief by neutralising acid. H2 blockers lower acid production to reduce oesophagal irritation and discomfort. Proton Pump Inhibitors (PPIs) are stronger, blocking acid production and promoting longer-lasting symptom relief.
This minimally invasive surgery involves making small incisions in the abdomen. A laparoscope (thin tube with a camera) and instruments are inserted to gently move the stomach back into position and tighten the diaphragm opening. Sometimes, a mesh is used to reinforce the area, reducing recurrence risk. Benefits include shorter recovery time, less pain, and fewer complications compared to traditional surgery.
This traditional surgical approach is usually recommended for larger or more complicated hernias. During the procedure, the surgeon makes a larger incision in the abdomen, allowing direct access to the hernia. The stomach is moved back to its proper position below the diaphragm, and the diaphragm opening is tightened. A mesh may be placed to reinforce the area and prevent future hernias. Recovery is typically longer than laparoscopic repair.
Preventing a hiatal hernia focuses on reducing pressure in the abdomen. Avoid heavy lifting and activities that require straining. Maintaining a healthy weight reduces abdominal pressure, lowering the risk of hernias.
Eating smaller, more frequent meals can prevent excess stomach pressure, which may help reduce symptoms. Avoid lying down immediately after eating to lower the chances of acid reflux, allowing time for proper digestion.
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*Extended Panel
MbChB (Sheffield)
M.Med (Surgery)
FRCSEd (General Surgery)
蘇萊曼·尤索夫博士
Dr. Sulaiman Yusof is a distinguished Senior Consultant in colorectal and general surgery, boasting over 15 years of expertise. His passion lies in minimally invasive techniques, particularly robotic surgery, where he has achieved remarkable success using the Da Vinci Xi system. Dr. Sulaiman is dedicated to delivering high-quality, personalized, and empathetic care, always striving for the best outcomes for his patients.
Dr. Sulaiman’s journey began at the University of Sheffield, where he graduated in 2002. He honed his skills during his house officer and basic surgical training in the UK before returning to Singapore. There, he completed his Advanced Surgical Training at Changi General Hospital and earned the Joint Speciality Fellowship in General Surgery in 2013.
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Most hiatal hernias are not life-threatening and often cause no symptoms. However, if left untreated, larger hernias can lead to complications, such as ulcers or strangulation, requiring prompt medical attention.
Yes, a large hiatal hernia can push against the diaphragm, which may restrict normal lung expansion. This pressure can make it difficult to breathe, especially after eating a large meal or during physical exertion, as the stomach’s abnormal positioning further compresses the diaphragm and surrounding structures.
Recurrence is possible but less likely if the surgical repair includes reinforcement, such as mesh placement to strengthen the diaphragm. However, following post-surgery care, such as avoiding heavy lifting and maintaining a healthy weight, is necessary to minimise the risk of recurrence and ensure the long-term effectiveness of the repair.