You may have heard of hernias, such as umbilical hernia, hiatal hernia, inguinal hernia, incisional hernia, surgical hernia, and so on. In fact, esophageal hiatal hernia is also a type of hernia, but it is a hernia that occurs inside the body and is not visible on the outside. What is a hiatal hernia? In the human body, the thoracic cavity and the abdominal cavity are separated by a flat muscle called the diaphragm. The diaphragm has a hole called the esophageal hiatus, through which the esophagus passes into the abdominal cavity and connects to the stomach. Under normal circumstances, the esophageal foramen is just large enough to accommodate the passage of the esophagus. However, due to various congenital or acquired factors, organs in the abdominal cavity (mainly the stomach) may pass through the diaphragmatic esophageal hiatus into the thoracic cavity and this type of disease is called esophageal hiatus hernia. Esophageal hiatal hernia is one of the common digestive system diseases, and its incidence increases with age, accounting for 10% of patients under 40 years of age and 70% of patients over 70 years of age. The disease is more common in women, obese, and people over 50 years of age. How does an esophageal hiatal hernia develop? The most common cause of esophageal hiatus hernia is chronic increased abdominal pressure. Pathophysiological conditions such as pregnancy, obesity, constipation, ascites, large intra-abdominal tumors, violent coughing, vomiting, frequent eruptions and habitual constipation can increase the abdominal pressure significantly, even exceeding the intrathoracic pressure, causing the stomach in the abdominal cavity to reverse through the esophageal hiatus and bulge upward into the thoracic cavity, inducing an esophageal hiatus hernia. In addition, congenital abnormal esophagogastric development, acquired esophageal lesions and structural changes in the diaphragm may also be rare causes of esophageal hiatal hernia. What are the manifestations of esophageal hiatal hernia Patients with esophageal hiatal hernia can be asymptomatic or have mild symptoms, and the severity of their symptoms is related to the size of the hernia sac and the severity of esophageal inflammation. There are three common symptoms as follows. 1. GERD symptoms: Esophageal hiatal hernia is an important factor in the occurrence of GERD. The typical symptoms of GERD are heartburn, acid reflux, belching, chest pain and acid vomiting. Sometimes there are some atypical manifestations, such as paroxysmal cough hoarseness, foreign body sensation in the throat, etc., which are actually manifestations of acid reflux into the esophagus in serious cases where esophageal reflux enters the trachea, asthma and aspiration pneumonia can occur. 2. Symptoms related to complications: hiatal hernia can sometimes bleed, mainly due to esophagitis and hernia bursitis, mostly due to chronic small amount of blood leakage, which can lead to anemia. Reflux esophageal stricture, in a few patients with reflux symptoms, organic stricture occurs, resulting in dysphagia, painful swallowing, vomiting after eating, and other symptoms. Hernia sac impaction, if a patient with hiatal hernia has sudden severe epigastric pain with vomiting, complete inability to swallow or simultaneous hemorrhage, suggesting acute impaction 3. Hernia sac compression symptoms: when the hernia sac is large and compresses the heart, lungs and mediastinum, it can produce symptoms such as shortness of breath, palpitation, cough and cyanosis, and when it compresses the esophagus, it can be felt as esophageal stagnation behind the sternum or difficulty in swallowing. How to identify an esophageal hiatal hernia In addition to symptoms and physical examination, some auxiliary examinations such as barium X-ray, gastroscopy, and abdominal CT and abdominal ultrasound are needed to diagnose an esophageal hiatal hernia. How to treat esophageal hiatal hernia: 1. Change the habits: reduce fat intake, avoid eating large pieces of food, reduce foods that stimulate gastric acid secretion and reflux, such as alcohol, caffeinated beverages, chocolate, onions, spicy foods, mint, etc., quit smoking, lose weight, avoid sleeping within three hours after eating, move more after eating, elevate the head of the bed during sleep, and reduce work pressure. 2.Medication: Acid-suppressing drugs can be taken. Most patients can reduce or control reflux symptoms by acid-suppressing drugs. Gastric power drugs can also be taken to enhance esophageal and gastric power to relieve symptoms. Endoscopic surgical treatment: endoscopic micro radiofrequency treatment, transoral endoscopic fundoplication, mucosal resection and folding, etc. 4.Surgical treatment: those who have failed in conservative treatment can undergo surgery. The commonly used method is laparoscopic esophageal hiatal hernia repair + fundoplication. For patients with severe symptoms of esophageal hiatal hernia for which medical treatment is ineffective, only surgical repair of the esophageal hiatal hernia can restore its normal size and rebuild the anti-reflux barrier.