What is an esophageal hiatal hernia? Our chest and abdominal cavities are separated by a flat muscle called the diaphragm, which has a hole called the esophageal hiatus. The esophagus passes through the esophageal hiatus in the diaphragm into the abdominal cavity and connects to the stomach. The esophagus passes through the diaphragm into the abdominal cavity and connects to the stomach. Under normal circumstances the esophageal hiatus is just large enough to accommodate the passage of the esophagus. The pressure in our abdominal cavity is greater than that in the chest cavity. When the esophageal hiatus is too large, the pressure difference will “suck” a small part of the stomach into the chest cavity, which is called an esophageal hiatal hernia. What are the signs of an esophageal hiatal hernia? Most hiatal hernias are seen in middle-aged and elderly patients, except for some congenital cases. Smaller hiatal hernias may be asymptomatic in the early stages or may only cause mild discomfort such as fullness and chest tightness after eating, which can be relieved on their own. Patients with hiatal hernias can be asymptomatic or have mild symptoms that are independent of the size of the hernia sac and the severity of the inflammation in the esophagus. Simply put, the symptoms of hiatal hernia patients are summarized in the following three aspects of the performance: 1, gastroesophageal reflux symptoms Typical symptoms are heartburn, acid reflux, belching, chest pain, spitting acid water, etc.; sometimes some atypical manifestations, such as: paroxysmal coughing, hoarseness, laryngeal sensation of a foreign body, etc., in fact, are the manifestation of the reflux of acid to the esophagus, the esophageal reflux of the severe cases of tracheal reflux into the trachea will also be asthma and aspiration pneumonia, etc.. In severe cases, esophageal reflux into the trachea can cause asthma and aspiration pneumonia. With the prolongation of the disease, hernia gradually increase will cause more obvious gastroesophageal reflux performance, at this time the hiatal hernia patient’s stomach is like a bottle of vinegar without a cap, gastric acid shaking on the overflow, it is very easy to reflux to the esophageal lumen and triggered a variety of symptoms of esophageal reflux. 2, complications related symptoms (1) bleeding: hiatal hernia can sometimes bleed, mainly due to esophagitis and hiatal hernia, mostly chronic small amount of oozing blood, can lead to anemia. (2) reflux esophageal stenosis: in patients with reflux symptoms, a small number of organic stenosis occurs, so that dysphagia, swallowing pain, vomiting after eating and other symptoms. (3) Hiatal hernia incarceration: generally seen in paraesophageal hernia. Hiatal hernia patients such as sudden severe epigastric pain with vomiting, completely unable to swallow or hemorrhage at the same time, suggesting the occurrence of acute incarceration. 3, hernia sac compression symptoms when the hernia sac is large compression of the heart and lungs, mediastinum, can produce shortness of breath, palpitations, cough, cyanosis and other symptoms. Compression of the esophagus can be felt in the sternum behind the esophageal stagnation or dysphagia. How is it diagnosed? Because this disease is relatively rare compared to general “gastroesophageal reflux” and there are no specific symptoms and signs, the diagnosis is more difficult, for gastroesophageal reflux symptoms, repeated treatment is ineffective, older, obese, and the symptoms of obvious correlation with the position of the suspected patients should be considered this disease. Diagnosis of hiatal hernia in addition to symptoms, physical examination, the conventional means of examination is gastroscopy and upper gastrointestinal imaging, of which X-ray examination is still the main method of diagnosis of esophageal hiatal hernia. X-ray barium meal examination: the most commonly used, the patient lying on the left side, head down, when the stomach is full of barium, the hand pressure on the abdomen, so that the patient to force the gas, at this time, hiatal hernia signs can appear. Gastroscopy: Gastroscopy is the second most important method of diagnosing hiatal hernia after radiological examination: if there is a hiatal hernia, it can be seen that the lower esophageal sphincter is flaccid, and it is open during expiration and inspiration; under normal circumstances, the esophagogastric junction point decreases during inspiration, and does not change to the same position if there is a hiatal hernia. When combined with reflux esophagitis, the number of erythema and ulcers can be observed by gastroscopy. What are the dangers of hiatal hernia? When the existence of esophageal hiatal hernia is ignored, often the patient’s symptoms can not be relieved or can not reduce the amount of medication, aggravating the burden on the patient and society; II, III hernia incarcerated will lead to necrosis of the hernia contents, resulting in bleeding or gastrointestinal perforation and other serious results; repeated esophageal reflux, acid stimulation, there is an increase in esophageal cancer incidence. How to treat esophageal hiatal hernia? A. Internal medicine treatment 1) Changing life habits: reduce fat intake, avoid chunky food, reduce foods that stimulate acid secretion and reflux such as alcohol, caffeine-containing beverages, chocolate, onion, spicy food, mint, etc.; quit smoking; lose weight; avoid sleeping for three hours after eating, and move around after eating; elevate the head of the bed when sleeping; reduce work pressure. 2) Taking acid-control medication: Most patients can reduce or control reflux symptoms with acid-control medication. (3) Taking gastric stimulants: Morpholine can be added to enhance esophageal and gastric stimulants to relieve symptoms. B. Surgical treatment: Surgery is needed if conservative treatment is ineffective. For patients with type II, III hernia and type I hiatal hernia with severe symptoms, as well as esophageal ulcer, esophageal stenosis, Barrett’s esophagus, esophageal function test confirms the presence of severe gastroesophageal reflux, severe bleeding and aspiration pneumonia, etc., surgical treatment should be actively adopted. At present, the method we recommend is laparoscopic hiatal hernia repair + fundoplication. Foreign studies have shown that: 1, esophageal hiatal hernia and Barrett’s esophagus, esophageal atypical hyperplasia and even cancer are closely related to the hiatal hernia patients with the incidence of the above conditions significantly higher; 2, esophageal hiatal hernia seriously damage the esophageal anti-reflux barrier, resulting in acid reflux symptoms and not easy to control; 3, esophageal hiatal hernia affects the esophageal contouring function, the food and refluxed gastric acid accumulates in the cavity of the hernia, aggravating symptoms. This aggravates the symptoms. Therefore, surgery is required for hiatal hernia with severe symptoms that are not treated by internal medicine, and only through surgery can these patients be treated for the cause of the disease – repairing the hiatus, restoring its normal size and rebuilding the anti-reflux barrier.