„The biggest problem is that patients with reflux symptoms live with them for years. For a long time, they do not consider them as a serious warning. Meanwhile, prolonged reflux can even lead to oncological changes in the esophagus, which, if not diagnosed in time, can make treatment much more difficult,“ says abdominal surgeon, oncologist, esophagus and stomach surgeon Dr. Martynas Lukšta.
Read more Tourists’ urine melts the Everest glacier: the scale determined by scientists is staggering
What is a hiatal hernia?
M. Lukšta explains that a hiatal hernia occurs when part of the stomach slips through the diaphragm opening into the chest cavity. Most often, patients are diagnosed with a sliding type, but in rarer cases, a paraesophageal hernia also occurs. The latter can be clinically more significant and dangerous, the doctor asserts.
The surgeon highlighted several main risk factors:
- age;
- overweight;
- increased pressure in the abdominal cavity;
- connective tissue weakness.
Reflux – the main symptom
One of the greatest significance of hiatal hernia is associated with gastroesophageal reflux. Due to anatomical changes, the lower esophageal sphincter weakens, allowing stomach acid to more easily enter the esophagus.
The most common symptoms:
- heartburn;
- regurgitation of acidic content;
- a burning sensation behind the breastbone;
- cough or hoarseness.
An important factor is that not all patients feel the mentioned symptoms, so the hernia is often diagnosed during incidental checks.
Is there a connection with cancer?
A hiatal hernia itself does not cause cancer. However, long-term reflux can damage the esophageal mucosa and cause Barrett’s esophagus – a precancerous condition.
It increases the risk of developing esophageal adenocarcinoma, but:
- the risk remains low;
- the process takes many years;
- effective monitoring is applied.
It is also important that a hiatal hernia is not a significant risk factor for stomach cancer.
Conservative treatment – the main choice
Most patients are treated without surgery. The main goal is to control reflux and protect the esophagus.
Treatment includes:
- lifestyle modification
- weight loss
- dietary changes
- raising the head of the bed
- medication (proton pump inhibitors, antacids)
- endoscopic monitoring if needed
These measures usually allow effective symptom control.
When is surgery needed?
Surgical treatment is not applied to everyone, but in certain cases, it becomes necessary:
- symptoms persist despite treatment
- the patient does not want long-term medication use
- complications arise (bleeding, strictures)
- a large or paraesophageal hernia is diagnosed
- there is a risk of incarceration or stomach volvulus
Large hernias – why is surgery important?
In the case of large hiatal (especially paraesophageal) hernias, surgery is often recommended even with minor symptoms. This is because:
Read more VRK proposes to recognize that Gintautas Paluckas did not violate the Election Code
- part of the stomach can become trapped in the chest cavity
- blood circulation may be impaired
- there is a risk of stomach volvulus
- complications can be acute and life-threatening
Therefore, in such cases, surgery is not only symptom treatment but also complication prevention.
“Large hiatal hernias are not just a discomfort problem – it is a condition that can suddenly complicate and become a reason for emergency surgery. Therefore, in such cases, planned surgical treatment is a safer choice,” emphasizes Dr. Martynas Lukšta.
Specialized surgery – not available in every center
Surgical treatment of hiatal hernias is technically complex and requires extensive experience.
During the operation:
- the diaphragm opening is narrowed
- the stomach is returned to the abdominal cavity
- fundoplication is performed
Although the procedure is usually performed laparoscopically, it is considered a specialized surgery.
Important to know:
- not all surgeons or hospitals have sufficient experience
- in Lithuania, these operations are performed by a limited number of centers
- results depend greatly on the surgeon’s experience
Therefore, patients are recommended to choose specialized centers.
When should you be concerned?
You must see a doctor if you experience:
- swallowing difficulties
- unexplained weight loss
- worsening or persistent heartburn
- anemia
In such cases, thorough diagnostics are needed, usually endoscopy.
Summary
Diaphragmatic (hiatal) hernia is a common and usually harmless condition, but it can be an important cause of reflux and over time lead to changes in the esophageal mucosa.
Most patients are successfully treated conservatively, but in the case of large hernias or complications, surgery becomes necessary. Since this is a complex and specialized procedure, it is very important to choose an experienced surgeon and an appropriate treatment center.
Early symptom assessment and proper treatment choice allow avoiding serious complications and ensuring a good quality of life.
