A giant hiatus hernia(GHH) is a more severe form of a hiatal hernia, where a large portion of the stomach with or without colon, small intestine, Omentum, or liver protrudes through the hiatus (the opening in the diaphragm) into the chest cavity. This condition differs from a regular hiatal hernia, which typically involves a smaller portion of the stomach.
GHH can be seen in people who have a large hiatus at birth, after a traumatic event where the hiatus( opening in the diaphragm) has been damaged or weakened, and in those who are having persistent high intra-abdominal pressure like Obesity, chronic cough, or chronic constipation which leads to regular straining while passing motion.
In this blog, we will explore how a giant hiatus hernia affects health, how to diagnose related complications, and the treatment options available to manage both the hernia and the associated problems.
The Link Between Giant Hiatus Hernia and Gastrointestinal Issues
As a giant hiatus hernia involves a large part of the stomach pushes through the diaphragm into the chest cavity, it can lead to a range of gastrointestinal issues, including.
GERD
Acid reflux, where stomach acid flows back into the esophagus, causing heartburn and sometimes regurgitation of food or acid, in the initial stages. As time goes by, a sense of fullness after ingesting small quantities of food is felt and this fullness persists for quite some time after meals.
Difficulty In Swallowing
Giant hiatus hernias can also cause difficulty swallowing, known as dysphagia. This occurs when the hernia creates pressure on the esophagus, making it harder for food and liquids to pass through. Dysphagia can lead to discomfort during meals and may even cause weight loss if the issue is not addressed.
Chest issues/Breathing problems
Later, chest discomfort , shortness of breath is experienced due the stomach pressing on the lungs and heart. Chest pain after meals is also a common complaint. This can incapacitate a person and day to day activities.
How serious is a Giant Hiatus Hernia?
If GHH is untreated, long-term reflux of acid from the stomach into the alkaline environment of the esophagus ( food pipe) can damage the cells lining the food pipe causing scarring and eventually cancer of the esophagus.
Stomach ulcers which can either bleed or perforate ( hole in the stomach)and cause an emergency, warranting an immediate surgery is another complication of untreated GHH.
Obstruction and Strangulation of the stomach that has entered into the chest could happen as the blood flow is compromised at the hiatal opening. This is also an emergency requiring immediate surgery.
Aspiration pneumonia can happen when the contents of the stomach in the chest don’t pass down quickly and regurgitate when a person sleeps into the wind pipe leading to sudden stop in breathing and death.
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Diagnosis
CT of the chest and abdomen is the surest method to diagnose a GHH.
An X ray of the chest, an upper GI endoscopy.
Managing a GHH
Treatment for a giant hiatus hernia often depends on the severity of the symptoms and the size of the hernia. In mild cases, lifestyle changes such as dietary adjustments and medications to reduce acid production can alleviate symptoms like reflux.
The following precautions need to be taken like having small meals, walking for sometime after a meal, lying down with the head end of the bed elevated, breathing exercises are the basic measures to be taken.
Medications to relieve GERD like PPI , prokinetics will help. Addressing Chronic cough or chronic constipation in order to prevent further progression is required.
Reducing weight if the person is obese will help alleviate symptoms and also prevent progression of the disease.
Examples of foods to avoid are fried and spicy dishes, certain vegetables like garlic, onions, and peppers, as well as smoked or salted fish. Pickles, vinegar, mustard, strongly flavored meats, sausages, and strong cheeses can also aggravate symptoms. Additionally, dried nuts, fruits, strong tea, coffee, alcohol, and chocolate should be limited to reduce discomfort.
Keyhole Laparoscopic Surgery: This is the only option to cure or correct a GHH . Also, in an emergency like obstruction or strangulation of the hernial contents, surgery is the only option.
Surgery involves:
• Reduction of the contents of the hernia from the chest like the stomach, intestine etc. back into the tummy.
• Repair the defect ( Hiatus) with stitches and a mesh to prevent further chances of the stomach entering the chest.
• Bariatric surgery in a person with severe obesity having uncomplicated GHH is an option.
Recovery after GHH surgery:
• Two to three hospital stays is what is required. Liquids for a week followed by a soft diet is what is advised avoid big meals. Rather small meals at intervals will help better.
• Chest physiotherapy before and after the surgery is very important and cannot be sidelined.
• Contributing and aggravating factors like obesity, constipation and chronic cough need to be addressed.
• Regular walk and balanced meals will help over years.
Conclusion
Treating a hiatus hernia in the initial stages will prevent progression to GHH. Also treating aggravating factors like obesity, constipation and chronic cough will prevent developing a GHH or progression to GHH.
