According to Abbreviationfinder.org, EHH stands for Esophageal Hiatal Hernia. A hiatal hernia, also popularly known as a diaphragmatic hernia, occurs when part of the stomach pushes through the diaphragm into the chest cavity. In most cases, a hiatal hernia will go undetected and will not cause any problems. In more serious cases, treatment up to and including surgery may be required.
What is hiatal hernia?
The diaphragm has a small opening (hiatus) through which the lower part of the esophagus enters the stomach below the diaphragm. In the most common cases (90-95%) of a hiatal hernia, the upper stomach moves through the diaphragm into the chest cavity (sliding hernia or axial hiatal hernia), causing the diaphragm to no longer close the esophagus and gastric acid to flow back (reflux).
In what is known as a paraesophageal hiatus hernia, part of the stomach pushes through the hiatus and, in the worst case, lies entirely in the chest cavity above the diaphragm. Other types of hiatal hernia are mostly milder forms and cause little discomfort. The likelihood of a hiatal hernia increases with age, affecting approximately 60% of all people aged 50 years and older.
Causes
The causes of a hiatal hernia are not fully understood. Pressure on the abdomen is assumed to be the main factor. The diaphragm is a large dome-shaped muscle that separates the chest from the abdomen.
Hiatal hernia occurs when the muscle tissue around the opening that allows passage of the esophagus to the stomach becomes fatigued. This can be caused directly by injuries to the diaphragm, but also by anatomical disorders (e.g. too large a hiatus).
Persistent strong pressure on the surrounding muscles is caused, for example, by coughing, severe vomiting, pregnancy or straining to have a bowel movement, as well as when lifting heavy objects. Aging and obesity are other risk factors for hiatal hernia.
Symptoms, Ailments & Signs
Depending on the type of hiatal hernia, various symptoms and symptoms can occur. The axial sliding hernia usually runs without clear signs. Some sufferers show the typical symptoms of reflux disease. Heartburn, belching, difficulty swallowing, and regurgitation of leftover food occur. In the case of a paraesophageal hernia, the disease takes a rapid and usually severe course.
In the first stage, there are usually no symptoms. In the uncomplicated stage, those affected suffer from belching and an increasing feeling of pressure in the heart area. The symptoms increase after eating and intensify as the disease progresses. Serious complications can occur in the complication stage, for example bleeding, constriction or severe stomach pain.
In severe cases, a stomach ulcer forms, which can manifest itself as stomach cramps and a strong feeling of being unwell. Furthermore, a hiatal hernia can lead to anemia and the associated poor performance, paleness and palpitations. Acute bleeding can also occur in the last stage of the disease.
However, life-threatening complications rarely occur. A hiatal hernia cannot be seen externally. However, sweating, pale skin, and sunken eyes are indicative of a condition that needs investigation and investigation.
Diagnosis & History
Hiatal hernia is similar to many diseases in its symptoms and is therefore rarely diagnosed directly. For example, a sick person may experience dull chest pains, shortness of breath (the effect of the rupture on the diaphragm), palpitations (due to irritation of the vagus nerve), or difficulty swallowing.
In most cases, a hiatal hernia itself will cause little discomfort. Pain and discomfort are often caused by reflux of stomach acid, air, or bile (heartburn) from a hiatal hernia.
Diagnosis of a hiatal hernia is typically made through tests ordered to determine the cause of heartburn or upper abdominal pain. This can be done using an X-ray of the upper digestive tract with test fluid or an endoscopy, in which a thin tube with a light and video camera (endoscope) is passed into the stomach.
Complications
A hiatal hernia can result in a variety of complications. It is not uncommon for gastric acid to flow back in an axial sliding hernia, also known as a sliding hernia. This in turn increases the risk of ulcers forming on the esophageal mucosa. In some cases, these ulcerations also lead to bleeding.
If a horizontal position is taken while sleeping, in severe cases the contents of the stomach may flow up towards the esophagus. Sometimes the patient breathes in the contents of the stomach or suffers from hoarseness. In addition, bronchial asthma can be aggravated.
Complications from a paraesophageal hernia are considered to be particularly unpleasant in the case of a diaphragmatic hernia. If the stomach twists in the chest and the diaphragmatic gap narrows, this makes it more difficult to transport food. This transit disorder becomes noticeable through swallowing difficulties or vomiting in the morning hours.
If it is a large hiatal hernia, it is conceivable that the upper part of the stomach will be pinched and bleeding will occur as a result. Due to chronic blood loss, there is a risk of anemia (low blood count). The dangerous complications of a diaphragmatic hernia include circulatory disorders in the pinched section of the stomach.
This process sometimes leads to serious consequences such as a stomach rupture (perforation) or peritonitis (peritonitis), which can assume life-threatening proportions. There is also a risk of complications during hiatal hernia surgery. This usually involves flatulence, injuries to the visceral nerve and postoperative bleeding.
When should you go to the doctor?
If the person affected repeatedly suffers from heartburn or has to belch regularly, it is advisable to ask a doctor to clarify the symptoms. Complaints about swallowing are considered unusual. If the food has already been sufficiently broken up in the mouth, swallowing difficulties should be examined by a doctor. If the symptoms lead to a refusal to eat or drink, a doctor is needed. A feeling of internal dryness is cause for concern because the patient is at risk of dehydration and, as a result, a life-threatening condition.
In severe cases, an ambulance must be called. In case of pain in the stomach or abdominal region, it is advisable to consult a doctor. Painkillers should only be taken in consultation with a doctor. Side effects can occur that contribute to further deterioration of health. If the affected person has to regurgitate regularly eaten food in a reflexive feeling, this is unusual.
The observation should be medically clarified and treated. If there are heart problems, an increased heart rate or increased heart activity, a doctor’s visit is advisable. If you have trouble sleeping, break out in a sweat or feel generally ill, you need to see a doctor. If bleeding occurs during bowel movements or urination, a medical examination should be initiated immediately.
Treatment & Therapy
In most cases of hiatal hernia, patients experience no discomfort and no action is required. Treatment is primarily aimed at reducing the symptoms caused by hiatal hernia.
Drugs used are designed to neutralize stomach acid (antacids), reduce acid production (H-2 receptor blockers), or heal damaged tissue. In a small number of conditions, a hiatal hernia may require surgery. This is especially true for emergencies and patients who cannot be helped by medication.
Surgery is recommended especially in the case of a gastroesophageal hiatal hernia, since chronic reflux can severely damage the esophagus and, in the worst case, lead to esophageal cancer. During an operation, the stomach is pulled back into the lower abdomen and the opening in the diaphragm is reduced.
Lifestyle changes can also help relieve hiatal hernia symptoms. Small meals throughout the day and a generally healthy lifestyle without alcohol are basic recommended measures. Symptomatic patients should sleep with their heads elevated and avoid lying down immediately after meals. Other recommendations for living with a hiatal hernia include stress -relieving relaxation techniques and reducing excess weight.
Outlook & Forecast
The prospects after a diaphragmatic hernia can be assessed as very good. In more than three quarters of all cases, no therapy is necessary at all. Then doctors speak of sliding hernias. They pass without any complaints. Otherwise, the characteristic symptoms can be eliminated with the help of medication. If an operation is performed, 90 percent of the patients can then go on living without any symptoms. The scientific situation can be classified as favorable in this context.
Newborns represent a risk group. Their lung volume is often restricted. If an operation has to be carried out, it is not uncommon for every second child to die. The prospects for patients in whom the diaphragmatic hernia recurs are also rather unfavorable. However, this rarely happens. The texture of the fabric is also unsuitable in very few cases. Then not all symptoms can be eliminated.
The hiatal hernia must go well during the surgical procedure. If complications arise, severe damage to the body often occurs. Inflamed tissues and released toxins are just a few of the negative consequences. As a result, ordinary participation in everyday life is no longer possible. Many of those affected die a short time after such surgical therapy.
Prevention
Since a hiatal hernia is primarily caused by increased pressure in the abdomen, heavy lifting or other mechanical impact should be avoided. In order to counteract internal stress, attention should be paid to a healthy intestinal flora to avoid constipation.
Aftercare
If conservative treatment with drug acid inhibition with proton pump inhibitors was successful or surgical therapy was carried out after recurrent reflux esophagitis and the patient is symptom-free and symptom-free, no postoperative treatment is necessary. Repeated follow-up examinations can also be dispensed with if there are no symptoms and the previous symptoms are absent.
A one-time check-up by the surgeon is usually sufficient. However, if reflux symptoms or associated reflux esophagitis occur, a repeat upper endoscopy, manometry and pH measurement is recommended. Immediately after a hiatoplasty, the transition zone between the esophagus and the cardia of the stomach is still swollen and irritated.
It is therefore advisable to avoid solid food in the first few days after the procedure. Since the lower esophageal occlusion is significantly narrowed during surgical therapy compared to the preoperative situation, minimal swallowing difficulties can remain as permanent complaints, as can mild gastrointestinal symptoms (bloating, diarrhea, restrictions or inhibitions in vomiting or belching).
In order to prevent these complications, attention should be paid to diet postoperatively and especially during the recovery period. It is advisable to optimize the diet with regard to personal intolerance and any other factors (digestibility, consistency) and also to allow enough time for food intake, to chew thoroughly and to consume liquids and food separately.
You can do that yourself
In addition to medical treatment, a hiatal hernia can be treated yourself using various tips and measures. Above all, a change in lifestyle contributes to alleviating the symptoms.
A healthy and balanced diet without alcohol, caffeine and other stimulants is recommended. Since a hiatal hernia is often caused by excess stomach acid, acid-producing foods (e.g., salt, sugar, dairy products, and fried foods) should be avoided. Alkaline products such as cucumbers, celery, carrots, grapes and red fruits are suitable. Food should be taken in small meals spread throughout the day. Overweight people need to reduce their body weight over the long term to repair a diaphragmatic hernia. Furthermore, the avoidance of stress applies, for example through targeted relaxation measuressucceed. Those affected should also sleep with their heads elevated and, if possible, not lie down after meals.
Furthermore, medications such as aspirin should be avoided, as these lead to an increased pH value. Medicines that contain estrogen or progesterone can weaken the hiatus muscles and should therefore not be taken either. If the symptoms do not subside despite the measures mentioned, it is best to consult a doctor.
