Hiatal Hernia Diagnosis- Complications- Treatment
Hiatal Hernia symptoms
Hiatus hernia diagnosis
Do you have hiatal hernia symptoms? If you have the symptoms of GERD which include Heartburn, and belching especially when you lean forward, lift heavy objects or when you lie down you should seek medical advice. If symptoms are accompanied by coughing, wheezing, asthma and sore throat or you have difficulty swallowing then you probably have acid reflux disease and should see your doctor immediately.
Your doctor may discover that you have a hiatus hernia while trying to determine the cause of your pain or heartburn, usually the hiatus hernia is found when he sends you for tests to determine if you have acid reflux disease.
The usual Acid reflux tests are Esophageal PH Monitoring, Barium X-ray, and Endoscopy.
Esophageal PH Monitoring
Esophageal pH monitoring is a test that measures how often and for how long stomach acid enters the esophagus, and how well it is cleared. You will have to prepare for this test by fasting; no eating drinking or smoking after midnight of the day the teat is to take place.
You will also have to stop taking your acid reflux medication as this can affect the test results so you will probably take none of the following medication 24 hours before the test. Antacids, H2 blockers, Proton pump inhibitors, Anticholinergics, Cholinergics, Adrenergic blockers, Corticosteroids. Also drinking alcohol should be avoided before the test. But you should not stop any medications unless told to do so.
The test is performed when a thin tube is down the throat and into the stomach then it is withdrawn so that is sitting in your esophagus. The tube is attached to a monitor which will measure the acidity. It will be worn for 24 hours and in that time a journal of your acid reflux symptoms and activity should be kept. When the tube is removed the next day the information you provide will be compared to the information recorded by the monitor.
The results will tell you whether you have heartburn or GERD, Esophagus problems like scarring or esophagitis pertaining to the frequency and the amount of stomach acid in the esophagus during the test. To determine the extent of damage other tests may be needed to be carried out.
Upper gastrointestinal tract radiography, also called an upper GI, is an x-ray examination of the pharynx, esophagus, stomach and first part of the small intestine. An x-ray examination that evaluates only the pharynx and esophagus is called a barium swallow.
A Barium x-ray is a painless medical test that helps physicians diagnose conditions such as GERD, and is a great aid to determine which heartburn treatment to use. The X-ray is also used to determine if a hiatal hernia is present.
The x-ray is a special type called fluoroscopy and uses Barium as a contrast material. By swallowing a chalky liquid containing Barium that coats the gastrointestinal tract the X-ray is able to able to show and assess the anatomy and function of the pharynx, esophagus, stomach and the duodenum.
The results can tell if stomach acid and other contents are causing damage to the esophagus.
Endoscopy is a minimal invasive medical procedure that works by inserting a flexible tube into the body. It is equipped with a fiber optic light and video camera and another tube which can take a medical instrument.
In our case the tube is inserted into the throat and esophagus and down to the stomach to check for inflammation scarring or any other signs of acid reflux disease. It is a most sensitive way of checking for symptoms of acid reflux and hiatal hernias. The instrument can be used to administer drugs and has the ability to hold a brush or instrument for taking tissue samples or removing damaged body tissue.
The endoscopy procedure is relatively painless and as most patients are usually sedated no pain is felt. Having both Gerd and a Hiatus Hernia I have had endoscopy twice and would have no anxiety if I had to have it again.
The results of your endoscopy will allow your doctor to proceed with the correct course of acid reflux medication.
Hiatal Hernia Complications
A hiatus hernia does not in itself carry any symptoms, but because it promotes acid reflux it has a strong link to gastroesophageal reflux disease (Gerd). In this way it is associated to heartburn, Gerd, Barretts esophagus and esophageal cancer.
It is mainly the sliding hernia which is associated with Gerd, but rolling hernias can strangulate a portion of the stomach which can protrude through the diaphragm. This strangulation can result in esophageal obstruction, even worse it can cut off blood flow which will kill cells and tissue. If you have severe chest pain on are not able to swallow you should seek medical help straight away as surgical repair may be required to your hiatus hernia.
It is now thought that only larger hiatal hernias play a part in acid reflux disease. At one time it was thought all hiatal hernias would give the symptoms of GERD but we now know that you may have a hiatal hernia and not get acid reflux at all.
Another severe complication, although very rare, is a large herniation that can restrict lung operation, causing pain, and breathing problems.
We know that the hiatus hernia can be a contributing factor in acid reflux disease but a further complication can be that you can develop Barretts esophagus from having GERD. Repeated long term exposure to acid reflux can develop abnormal change in the cells of the lower esophagus. Barretts esophagus is found in about 10% of heartburn sufferers. It is considered to be a premalignant condition and is associated with an increased risk of esophageal cancer.
Most hiatal hernias do not have any symptoms so you will not need any treatment if this is the case. However if you have repeated heartburn and an acid reflux symptom the treatment is usually for the acid reflux not the hiatus hernia. Lifestyle changes are requires which are dealt with in our other articles on lifestyle.
If changes in lifestyle are not enough then you should see your doctor for heartburn medication like h2 inhibitors or stronger proton pump inhibitors which stop the production of stomach acid.
Natural cures are another alternative if you want to take the holistic route.
And there are surgical procedures that can be used. Nissen fundoplication open surgery and laparoscopic keyhole surgery.
Whichever treatment you take or are recommended for your acid reflux disease taking self care and lifestyle changes can only change your life for the better.