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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 hiatal 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 at least 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 gastro esophageal reflux associated with GERD. Pregnant mothers are advised not to undergo this procedure as the risk of radiation affects the fetus.


Barium Swallow Test

Barium sulfate is a popular compound used in the diagnostic investigation of abnormalities of internal organs. This test is used to investigate issues of upper gastrointestinal tract. Most cases in this diagnostic category include abnormalities associated with esophagus and the digestive system. Barium swallowing procedure determines the presence of anatomical abnormalities such as narrowing of the esophagus, abnormal growths such as cancer, tumors, polyps and also for the presence of foreign objects as a result of ingestion. Barium swallow test also helps in the identification of conditions such as hiatal hernia. In this condition, the upper portion of the stomach protrudes into the chest cavity through the diaphragm opening called esophageal hiatus.


Preparation for Barium swallow test

Since barium swallow is a radiological procedure, patients are usually advised not to take any food the night before the test. This enables the radiologist to analyze and discover underlying abnormalities in the gastro intestinal tract. Presence of food particles can mask the diagnosis to a great extent. The radiologist may make general enquiry to ensure that the patient is not pregnant or on insulin. Before the test is performed, the patient is advised to drink a milky liquid. This liquid contains barium sulfate. Many patients complain about the chalky taste of this liquid.


In some cases, it induces nausea. In addition to the barium sulfate liquid, the patient is also advised to take few pills that produce bubbles or effervescence. The effervescence induced by the pills is necessary to facilitate the air in to the stomach to view the structures carefully. Patients are advised not to belch although the procedure induces it. This enables the radiologist to identify the underlying disorders better. The risks associated with barium swallow test are minimal. One of the most common side effects of this test is constipation. Other conditions include anaphylactic reactions and aspiration in which the ingested barium enters the windpipe. The entire procedure may last around 30 minutes. Fluoroscopy is often used during a barium swallow.


Barium enema

Barium enema is advised for patients who experience difficulties in bowel movements and also associated conditions such as weight loss and anemia. Barium sulfate is administered through the anus by using a tube to investigate the bowel disorders in the patient. This radiological examination gives a complete picture of the bowel beginning from the colon to the large intestine. Abnormalities such as colon cancer, polyps, peptic ulcer disease, GERD (Gastro Esophageal Reflux Disease), achalasia, strictures and tumors can be identified with this method. Drugs such as buscopan are given to the patients to relax the bowel.


Patients are advised not consume any solid foods or milk products as it may hinder the diagnosis. The recommended diet for the patients undergoing this test is usually clear fluids and juices. Although the test has minimal side effects, many patients experience the inconvenience of cramping during the procedure. The intensity of cramping varies from person to person. Bowel relaxation drugs are administered to prevent unprecedented events during the procedure. During the procedure, patients often experience the urge to defecate which has to be controlled in order to obtain proper diagnosis of the bowel. One of the significant risk factors associated with this procedure is the leakage of barium from previously perforated colon. The side effects of the leaking barium from the colon can be fatal. Hence, thorough preparation is done before the test to ensure and minimize the risk factors. Pregnant women are not advised to do this procedure. After this test, patients are asked to drink extra fluids and water to relieve the bowels of the barium.

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Collection of Pages - Last revised Date: November 11, 2019