You could be in the dark if you often experience heartburn or feel excessively full after meals and are attributing it to your diet. An excess of acid might manifest as bloating, burning feelings in the chest and stomach. However, it may occasionally stem from underlying problems as well. A hiatus hernia is one example. Symptoms of hiatal hernia may resemble those of routine, mundane gastrointestinal disorders. Dr. Aparna Govil Bhasker, a Mumbai-based consultant bariatric and laparoscopic surgeon at MetaHeal - Laparoscopy and Bariatric Surgery Centre, discussed how the illness affects those over 50.

"55 to 60% individuals over the age of 50 years may be suffering from a hiatus hernia," she stated in explaining the prevalence and contributing causes. Between 9 and 10% of them exhibit symptoms. The origin of hiatus hernia might be either inherited or acquired. Obesity, pregnancy, chronic constipation, COPD, and other factors contribute to the pressure increase in the abdomen. Its development may also be influenced by other variables, such as genetics, prior operations, and trauma. Muscular weakness is the primary cause.

Dr. Aparna described what occurs in the gut during hiatus hernia by breaking down what really transpires within the body. The symptoms are frequently overlooked since they resemble common gastrointestinal ailments such heartburn and acid reflux.

"In a hiatus hernia, the upper portion of the stomach pushes through the diaphragmatic aperture into the chest, endangering the muscular valve at the lower end of the food-pipe," she said. Gastroesophageal reflux disease (GERD) can result from this loosening and relaxation of the valve, which may allow acid and contents from the stomach to reflux into the esophagus. Most small hiatal hernias have no symptoms and are typically treated with drugs. Surgery, often in the form of a laparoscopic fundoplication, is typically necessary for severe hiatal hernias. The majority of minor hiatus hernias are asymptomatic when they are small.

Dr. Aparna provided a handbook that covered the key elements of hiatal hernia, from symptoms and signs to therapies.

Signs of a larger hiatal hernia

• Belching, vomiting
• Heartburn and acid reflux
• Abdominal or chest pain
• Difficulty in swallowing
• Feeling very full, especially after meals
• Passing black stools or vomiting blood, which at times is an indication of gastrointestinal bleeding
• Change in voice

How to prevent and treat

• Lifestyle modification is the first line of treatment. Since most hiatal hernia symptoms stem from acid reflux, dietary modifications can help significantly.
• Eating smaller, more frequent meals instead of three large ones, avoiding heavy meals or snacks close to bedtime, quitting smoking are all simple but effective measures.
• Patients are also advised to avoid lying down or bending over soon after meals to prevent heartburn.
• Medications play an important role in managing symptoms of hiatal hernia, especially those related to acid reflux. Antacids are commonly used to neutralise stomach acid, while H2-receptor blockers help reduce acid production. Proton pump inhibitors (PPIs) are another effective option, as they block acid production completely, giving the food pipe time to heal.

When surgery may be needed

• Surgical repair is needed when the patients are unable to stop medical treatment, if there is no relief despite medical management.
• When the patient develops complications like oesophageal ulcers, reflux in the windpipe, Barrett's oesophagus, etc.
• Laparoscopic fundoplication is a commonly performed minimally invasive surgery in such cases, which leads to symptom relief and also prevents future complications. A fundoplication involves bringing back the herniated contents from the chest into the stomach, tightening the loose valve and creating a wrap of the stomach.

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