Hiatal Hernia
A hernia is a condition where a part of the body protrudes through an opening into another part of the body. Most hernias are found in the abdominal area. A hiatal hernia is usually located at the opening of the diaphragm and is an anatomical abnormality of the esophagus. Then the hiatal hernia displaces the muscle band at the lower end of the esophagus (lower esophageal sphincter) and leads to gastroesophageal reflux. As a result, stomach acid flows into the esophagus leading to esophagitis. Hiatal hernia is noticed among obese persons and those who have sustained an injury to that part of the body. Women are at increased risk and so are smokers.
Heartburn is the primary complaint of patients suffering from hiatual hernia. There is belching and feeling of vomiting. Many patients feel that there is something lodged in their chest. Coughing, vomiting or physical exertion can worsen the symptoms of hiatal hernia. The symptoms worsen during pregnancy, lying down or lifting heavy objects. In some cases, a hiatal hernia may go unnoticed. Lifestyle changes like eliminating coffee, alcohol and smoking can help relieve some of the symptoms associated with hiatus hernia. Sleeping with the head at a mild elevation can help prevent stomach acid reflux at night.
A barium x-ray can help in examining the upper digestive tract and checking for any backlash of stomach contents into the esophagus. An endoscopy helps diagnose a hiatal hernia and check for any inflammation of the esophagus. Antacids can help in neutralizing stomach acid. Drugs such as ranitidine, omeprazole or cimetidine are prescribed to reduce the secretion of stomach acid. Surgery is resorted to when there is a possibility of reduced or obstructed blood supply. This is done through laparoscopy to reduce pain, scarring and chances of infection.
Esophagram
Esophagram is a test whereby the patient is administered a barium sulfate compound that enables the radiologist to study the function and appearance of the esophagus. A series of x rays of the esophagus is taken after the patient has swallowed the barium. The barium solution coats and outlines the walls of the esophagus. This enables the radiologist to assess the process of swallowing. Hence it is also called barium swallow. An Esophagram is done when the patient complains of pain or difficulty in swallowing. It is also done to assess the reasons for blood stained vomit and when abdominal pain and weight loss occurs or diagnosing cases of Barrett's esophagus. The Esophagram helps the radiologist to detect narrowing, stricture, obstruction or irritation of the esophagus. It helps to study complications such as ulcers, polyps and tumors. It also helps to assess hiatal hernia.
The patient is advised not to eat or drink for 8 to 10 hours prior to the examination. The patient is asked not to smoke or chew gum atleast 6 hours prior to the procedure. A patient is given a cup of barium sulfate to swallow. A radiologist watches and evaluates the swallowing process with fluoroscopy. The barium swallowed coats the lining of the esophagus, and x rays are taken to track the pathway to the stomach. The patient is placed in various positions throughout the exam so that structures are optimally demonstrated on the x rays.
The problem is that it can miss small abnormalities in the esophagus such as small erosions and ulcers. This test is not very effective for diagnosing gastroesophageal reflux associated with GERD. Pregnant mothers are advised not to undergo this procedure as the risk of radiation affects the fetus.
Schatzki's Ring
Schatzki's Ring or esophagul ring refers to a smooth and narrow ring of tissue in the lower end of the esophagus. It narrows down and blocks the esophagus. This esophagul ring is noticed among nearly 6% of the population. Schatzki's Ring is usually associated with long term damage due to stomach acid reflux. It can also occur due to a congenital defect. Schatzki's Ring is often associated with a hiatal hernia. Some chunks of food may get caught in the ring and lead to dysphagia (difficulty in swallowing large pieces of food). The degree of difficulty in swallowing depends on the extent of narrowing of the esophagus.It also results in chest pain under the sternum. But very often persons suffering from Schatzki's Ring are unaware of it.
A gastroenterologist can help in treating Schatzki's Ring. An EGD (esophagogastroduodenoscopy) or barium swallow aid in diagnosing this condition. Endoscopic examination of the esophagus also helps in diagnosing Schatzki's Ring. Drinking plenty of fluids and eating soft food can help tackle this. Surgical dilation of esophagul ring with a mercury -filled dilator (bougie) can offer relief. Dilators are passed into the mucosal ring to ease the symptoms. The lower esophagul ring tissue can be surgically removed too.
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