Hiatus Hernias

Hiatus Hernias occur when part of the stomach is displaced through the oesophageal (gullet) hiatus (gap) in the diaphragm thus the term “hiatus hernia”. These hernias are very common but not all of them give any symptoms. The commonest type is called a sliding hiatus hernia.

Normally acid from the stomach is prevented from refluxing into the gullet by a sphincter mechanism. However with a hernia this is disturbed and reflux of acid into the gullet occurs causing the main symptoms and problems.

These are:
a) “Heartburn” behind the sternum. It is often made worse by lying down or stooping.
b) Reflux of the acid or fluid can reach the mouth where there is an acid taste – called waterbrash.
c) Belching wind is common.

As the reflux becomes worse, difficulty with swallowing can become a problem. An ulcer may develop associated with the inflammation (oesophagitis) and anaemia may result.

With a large hernia there may be flatulence, a sense of fullness or distension and even shortness of breath, but rarely the hernia can even twist or incarcerate.

In addition some of these symptoms may mimic those of gallstones or even heart pain.

This is usually based on the clinical history. Confirmation is required by the use of gastroscopy. In certain circumstances barium swallow or meal.

Medication and the cessation of smoking and avoidance of precipitating factors are the main lines of treatments.

When these treatments fail and when the symptoms are severe and persisting then surgery may be considered.

The surgery is a complex abdominal intra-abdominal operation but has been simplified more recently by the use of laparoscopic (keyhole surgery). The operation is termed fundoplication.

Before this operation is carried out careful assessment is required to ensure that the operation is being carried out for the correct reasons and that the surgery is likely to cure the problem.

These investigations include:
a) Gastroscopy,
b) Barium swallow,
c) Gastric acid secretions,
d) Oesophageal manometry – that is a measurement of the pressure at the lower end of the oesophagus.

These tests assess reflux of acid into the gullet.

These investigations are usually carried out by a Specialist Gastroenterologist or Surgeon with a particular interest in that area.

The surgery usually requires hospitalisation for a few days and is carried out under General Anaesthesia. Apart from the normal complications of surgery the specific complications associated with the repair of a hiatus hernia are that if the repair is too tight, the patient may get difficulty swallowing and find it also difficult to burp. They have a feeling of distension.

Because of the need for careful assessment, hiatus hernia patients from Interstate, need to be assessed in their state of origin. They would most likely prefer to have the surgery there.

We would be happy to help arrange this with the appropriate referral to a Specialist in your state or country centre.

If you are in Melbourne, Dr Ian Bejer works in association with you and would arrange appropriate investigations.