The diagram on the right shows the inside of a human. The chest and abdomen are separated from each other by a sheet of muscle called the diaphragm.
The tube that takes food from your mouth to your stomach has to go through the chest and into the abdomen. This is called the oesophagus (or the “gullet”).
It gets into the abdomen through a hole in the diaphragm called the “hiatus”. This hole lets the oesophagus (gullet) through and keeps the stomach in the abdomen below it.
Hiatus Hernia
In some people, the hiatus can enlarge and the stomach can slip up into the chest through it.Diagram of what a Hiatus Hernia is – The herniation of the Stomach slipping up through the hiatus in the diaphragm and into the chest
In medicine, when something pushes out of an area it should stay in, it is called a hernia.
Therefore, the stomach “herniates” through the hiatus in the diaphragm and moves into the chest.
As such, anything that is in the stomach – including food, drink and stomach acid, can now move easily back up into the oesophagus (gullet).
This is the cause of the usual symptoms of hiatus hernia:
– heart burn or food regurgitating into the back of the throat on lying down, straining or bending forwards.
Treatment
Diagram of surgical repair of a Hiatus Hernia – called a Nissin FundoplicationIf a doctor suspects a hiatus hernia, they usually ask for an endoscopy (a thin flexible tube put down the throat and into the oesophagus to see what is going on) or an X-ray with the patient drinking some contrast (which shows up on X-ray).
Treatments can be:
Conservative:
Lose weight, wear loose belts and clothes
Drugs, to prevent the contact of stomach acid on the oesophagus, or to reduce the stomach acid
Surgery (see diagram):
Can be done open or by “keyhole” (laparoscopic) surgery methods
The stomach is pulled down into the abdomen, the top is wrapped around the lower oesophagus and the hiatus is stitched smaller
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