Are there also diaphragmatic hernias that do not cause symptoms?
The most common form of diaphragmatic hernia, the acquired hiatus hernia, is asymptomatic in the majority of cases. The severity of the hernia is often small, only the narrowing at the transition from esophagus to stomach is somewhat dilated. Frequently, a small hiatal hernia is noticed as a coincidental finding during a gastroscopy, which is performed because of other complaints.
However, such a finding has no consequences as long as there are no symptoms that can be attributed to the hernia. The extent of the therapy always depends on the patient’s symptoms. More about this type of hernia can be found on our page Axial Hiatus HerniaThe classic symptom of acquired diaphragmatic hernia (hiatus hernia) is heartburn, also called reflux.
Due to the dilatation of the diaphragm at the passage of the esophagus the constriction in front of the stomach entrance is missing and gastric acid runs back into the esophagus. This causes a burning and unpleasant feeling behind the breastbone and can be accompanied by frequent burping. However, reflux over a long period of time can cause ulcers of the esophagus and even malignant changes.
This can usually be prevented by daily intake of so-called proton pump inhibitors (PPIs, e.g. Pantoprazole). Shortness of breath as a symptom in an adult diaphragmatic hernia is rather rare and is an indication that there is already a lot of abdominal organ in the thorax which displaces the lung. The shortness of breath does not occur suddenly but develops over time.
It is usually associated with heartburn and a feeling of fullness and sometimes gets worse after eating. In case of sudden and persistent shortness of breath without symptoms from the gastrointestinal tract, a doctor should be consulted urgently, as it may be a pulmonary embolism or a heart attack. In infants, however, shortness of breath after birth is typical of a congenital diaphragmatic hernia and should be examined and surgically treated immediately.
If the stomach lies partly in the thorax and partly in the abdominal cavity, the constriction of the stomach in the diaphragmatic gap can lead to chronic irritation of the mucous membranes in these places.Over time, this irritation develops into ulcers, which can also bleed. The residues of these bleedings can be noticed by coffee grounds-like dark flakes when vomiting. However, life-threatening, insatiable bleeding in the stomach is extremely rare in diaphragmatic hernias.
Taking PPIs helps here as well, but surgical treatment should be considered at such a stage. Oozing bleeding from ulcers of the stomach and esophageal mucosa can cause anemia for a long time. The ulcers bleed again and again and thus not only a certain blood loss but also an iron deficiency occurs, which in turn causes anemia.
This can be clearly seen in the blood count, because the anaemia caused by iron deficiency is characterized by small red blood cells that are low in haemoglobin. It is quite rare for abdominal organs to become trapped in a diaphragmatic hernia. Over time, the organs are surrounded by a connective tissue envelope at their new location and thus grow solid.
However, incarcerations, be it of the stomach or parts of the intestine, in a hiatus hernia are known and represent a serious clinical picture. An incarceration is characterized by rapidly worsening and persistent abdominal pain, which can become unbearable. The blood supply to the incarcerated organ is cut off, oxygen is no longer available and the tissue threatens to die. Rapid surgical treatment is vital.
