A hernia is an opening in a body wall or cavity that causes body organs to push through it. Hiatal hernia is the term used to describe a medical condition where part of the stomach pushes up into the lower chest through a weakness in the diaphragm. The diaphragm is the large flat muscle that separates the lungs from the tummy (abdomen) and helps us to breathe. Stem cell therapies have been proposed in preclinical trials as new treatment options
Types of Hiatal Hernias
There are majorly two types of hiatal hernia: sliding Hiatal hernias and fixed hernias, also known as paraesophageal hernias.
- Sliding hiatal hernia – This is the more common type of hiatal It occurs when your stomach and esophagus slide into and out of your chest intermittently through the hiatus. Sliding hernias tend to be small. They usually don’t cause any symptoms. They may not require treatment.
- Fixed hiatal hernia – This type of a hernia isn’t as common as the sliding hiatal hernia. It’s also known as a paraesophageal In a fixed hernia, part of your stomach pushes through your diaphragm and stays there. It does not slide back out like in sliding hernias and it is more likely to cause symptoms but most cases are not serious. However, there is a risk that blood flow to your stomach could become blocked. If that happens, it could cause serious damage and is considered a medical emergency.
CAUSES OF HIATAL HERNIA
The cause of hiatal hernias in many cases are not known because they happen to people of all ages and there are usually no symptoms. A couple of factors have however been highlighted as risk factors and possible causes of hiatal hernias. They include:
- Injury/Trauma – Trauma or an injury could lead to an expansion in the opening of the diaphragm causing a hernia of the stomach through it.
- Congenital – Some people are born with a larger than average opening in their diaphragm which makes it easier for the stomach to slip through. This can usually be treated with surgery early on in life.
- Aging – The chances of having a hiatal hernia increase as you get older. The diaphragmatic muscles naturally become weaker and more flexible with advancing age, and, as you get older, you are more likely to experience the risk factors for a hiatal Exceptions include congenital (from birth) and hereditary hiatal hernia, which develops at an early age.
- Surgery – Abdominal surgery may lead to weakness in the diaphragm or abdominal walls thereby increasing your chances of developing a hiatal hernia.
- Obesity – Statistics have shown that obese people are more prone to developing hernias. The reason for this is not very clear.
- Repeated Pressure Activities – People who are constantly lifting heavy objects or straining their abdominal muscles while defaecating or through frequent coughing, vomiting, etc are more prone to developing hiatal This is because the constant over-use of the abdominal muscles leads to weakness over time.
- Smoking – Statistics have also shown that people who smoke are more likely to develop hernias. The reason behind this is also not very clear.
Signs and symptoms of Hiatal Hernias
Hiatal hernias usually don’t cause any symptoms for a long time or even for a lifetime, so it’s hard to know the extent to which people are affected. It’s commonly detected during a routine check-up on a Chest x-ray. When people do experience symptoms, it’s because of associated conditions, aging or a complication. Possible symptoms include:
- Heartburn – This is a burning sensation felt in the chest mostly due to regurgitation of food or a condition known as Gastro-esophageal reflux disease which can occur as a complication of Hiatal hernias. The persistence of GERD symptoms can lead to a chronic cough, chest pain, asthma, and progressive damage to your tooth enamel.
- Regurgitation – When the stomach rolls into the lower chest, it can cause food to go back up as well. When this occurs frequently, it could be a sign of a hernia.
- Belching or hiccuping shortly after eating – This is a relatively normal reaction but when it happens very often it could be due to an underlying disease.
- A stinging sensation in the throat
- A sour or bitter taste in the mouth
- Bad breath
Treatment of Hiatal Hernias
Most cases of hiatal hernias especially the non-symptomatic ones don’t require treatment. The presence of symptoms and the type of symptoms usually determines treatment. For people with mild symptoms, weight loss, stopping smoking, adopting proper hydration habits or making dietary changes may do the trick. However, If you have acid reflux and heartburn, you may be treated with medications or, if those don’t work, surgery.
Common Medications used include:
- Antacids – These are medications that counteract the acidic contents of the stomach thereby protecting its lining from ulcers. They are given to people who experience heartburns alongside other medications to relieve their symptoms. When used over a long period of time, they can cause diarrhea or constipation. A popular brand is Gaviscon.
- H2 Blockers – These are medications that reduce the production of stomach acids. They are also used to relieve heartburn symptoms and protect the stomach and esophageal lining from damage. Side effects include constipation, diarrhea, dry mouth, headaches, and ringing in the ears. A popular brand is Pepcid.
- Proton pump inhibitors (PPIs) – These perform a similar action to H2 blockers but are stronger and faster. PPIs are more typically used if an H2 blocker fails to provide relief. A headache, constipation, diarrhea, and flatulence are common side effects. A popular brand is Nexium.
Surgery for a hiatal hernia is only indicated if a fixed hernia is causing symptoms that cannot be treated with medications or lifestyle changes. There are 2 major types of surgeries that are performed :
- Open Surgery – This is not commonly done except a hernia has become so large as in the case where the entire stomach has slipped into the chest cavity (known as an intrathoracic stomach). In this case, doctors make a standard incision in the chest or abdomen and then put the stomach back into place. They then try to make the hiatus smaller so as to prevent it from reoccurring.
- Laparoscopic surgery – This is also called a keyhole surgery and it involves the insertion of multiple surgical instruments into three more keyhole-sized incisions in the abdomen. For non-emergency situations, it is considered just as effective as open surgery but with far fewer complications and a quicker recovery time.
The use of Stem cell therapy for the treatment of Hiatal Hernias
Stem cell therapies have been proposed in preclinical trials as new treatment options in the abdominal wall and Hiatal hernia repair. The idea is that in cases where there is a large opening, stem cells can be developed into diaphragmatic tissue and then used to close up the opening. This would present with little to no complications and could serve as a life-long solution.
Duranceau, A. (2015). Massive hiatal hernia: a review. Diseases Of The Esophagus, 29(4), 350-366. doi: 10.1111/dote.12328
Fisichella, P., Andolfi, C., & Patti, M. (2015). Laparoscopic Paraesophageal/Hiatal Hernia Repair. Csurgeries. doi: 10.17797/56by9lqzf5Get More Stem Cell Information at iSTEMCELL