A hiatus hernia is a shift of parts of the stomach into the thoracic cavity through the opening of the diaphragm. Normally, the esophagus lies in this opening and the stomach only begins underneath. The axial hiatus hernia is a sliding hernia.
The upper part of the stomach slides through the opening into the posterior part of the so-called mediastinum. This is the area of the thorax between the lungs. Older, overweight people are more often affected. In many cases, those affected have no complaints.
What forms are there?
There are different forms of diaphragmatic hernias. One form is the axial hiatal hernia, in which the upper part of the stomach, also called cardia, slides up through the diaphragmatic opening. This form is more common than other forms.
Furthermore there is the paraesophageal hernia. Here parts of the stomach next to the esophagus are stuck in the diaphragmatic opening, while the transition between esophagus and stomach is normally located in the abdominal cavity. The jammed stomach parts can lead to bleeding and passenger disturbances.
Another name for the axial hiatus hernia is sliding hernia. Normally a large part of the esophagus is located in the thoracic cavity and about two centimetres below the diaphragm is the transition to the stomach. With an axial hiatal hernia this ratio shifts.
The lower two centimetres of the oesophagus and the transition to the stomach glide upwards into the chest cavity. The displaced organ parts thus slide along the normal, anatomical axis and thus give the axial hiatus hernia its name. Older and overweight people are particularly affected by this type of hiatus hernia.
A loosening of the diaphragm, which is a muscle, at the site of the opening can increase the probability of an axial hiatus hernia. A deformed transition between the stomach and oesophagus can also be a risk factor. Most affected patients do not have any symptoms from the hernia and often do not even know of its existence.
In some cases heartburn, chest pain and swallowing difficulties may occur. Therapy is only necessary if there are complaints. In this case a conservative therapy with acid blockers is tried first and only in extreme cases an operation is performed.
The axial hiatus hernia is the most common form of hiatus hernias and often remains undetected and without symptoms. The paraesophageal hernia is a less frequent form of hiatus hernias. Just like the axial hernia, it is a relocation of parts of the stomach into the thoracic cavity, but here the transition of the esophagus and stomach remains in the abdominal cavity.
Therefore both the esophagus and the stomach parts lie in the diaphragm opening and the stomach can be trapped. This can lead to bleeding in the stomach and even anaemia. In extreme cases this can lead to an upside-down stomach. This means that the entire stomach is located in the chest area, which can cause respiratory problems in addition to the stomach problems. An upside-down stomach requires treatment.