Hiatal hernia: what are the possible treatments?

The hiatal hernia is the most frequent lesion of the digestive system: 20% to 60% of the population in France would be concerned *.

Often asymptomatic (no pain, no gene ...), hiatal hernia usually goes unnoticed. And while the experts do not yet know exactly what leads to its formation, it is now accepted that overweight, obesity and age are risk factors.

Hiatal hernia: what is it?

Schematically, we speak of hiatal hernia when a part of the stomach (an organ that is normally completely contained in the abdomen) "goes up" in the thorax.

"Part of the stomach passes through the hiatal orifice of the diaphragm, which is the "hole" through which the esophagus enters the abdomen, develops Prof. Frank Zerbib, gastroenterologist. This phenomenon occurs when the means of attachment of the stomach and the esophagus are defective."

There are two forms of hiatal hernia:

• The Hiatal hernia by rolling This is the rarest since it represents only 10% of cases *. It occurs when the stomach slides down the esophagus above the diaphragm.
• The sliding hiatal hernia : it is to her that we are dealing in 80% of the cases *. It occurs when the junction between the stomach and the esophagus (called the cardia) slides towards the thorax, taking with it part of the stomach.

"In itself, the hiatal hernia is not serious, it is only an anatomical anomaly, explains Prof. Zerbib. In rare cases (when the hernia is very large), we can observe a anemia, linked to a mechanical ulceration: the mucosa is damaged at the level of the constriction, so it bleeds slightly. There may also be symptoms of compression (with chest pain, vomiting ...) in the case of a hiatus rotating hernia."

In contrast, the presence of a hiatal hernia is a risk factor favoring the development of gastroesophageal reflux disease (GERD). This rise of a portion of gastric contents in the esophagus would affect each month between 30% and 45% of the French population.

What are the treatments for hiatal hernias?

"If the hiatal hernia is asymptomatic or if it manifests itself only by gastro-oesophageal reflux, surgery is not necessary: ​​we can be content with a long-term drug treatment"explains Prof. Zerbib.

But if the hernia is very bulky, there are symptoms (GERD but not only) and / or the drug treatment is ineffective, it must go through the box "surgery".

First stage : o-gastro-duodenoscopy (EOGD), a medical examination that examines hiatal hernia. This gastroscopy is performed under local anesthesia: with the help of a flexible tube equipped with a camera (the endoscope) the doctor can observe the area. In addition, a chest X-ray and / or CT scan of the chest and abdomen may be necessary, especially in case of hiatal hernia rotation.

Second step, the surgical procedure: performed by laparoscopy (a minimally invasive surgical technique that allows access to the inside of the abdomen via small incisions of the abdominal wall), it aims to correct the hiatal hernia.

"It takes place schematically in three stages, explains Prof. Zerbib. First, we go down the stomach in the abdomen. Then, an anti-reflux valve is made by making a "tie knot" with the upper segment of the stomach, at the junction with the esophagus - this is called the Nissen operation. Finally, it tightens the hiatal opening so that the hernia can not reoffend."

Result? After surgery, symptoms disappear within one year in 90% of cases; within 3 years in 83% to 93% of cases.

* Source: SNFGE

Thanks to Prof. Franck Zerbib, gastroenterologist and hepatologist, member of the French National Society of Gastroenterology (SNFGE).

Read also :

⋙ Stomach cancer: what are the symptoms that should not be ignored?

⋙ Hiatal hernia: how to recognize the symptoms of this digestive system disorder?

⋙ Epigastric pain: what to do when you have a stomach ache?