Rolling Hiatal Hernia Review

Rolling Hiatal Hernia

The term “rolling” as it refers to a hiatal hernia can be rather misleading. A rolling hiatal hernia is simply another term for a paraesophageal hernia, the more serious of the two common types of the condition. It has been estimated that nearly one out of every five people have a hiatal hernia, and the majority of them either are not aware or do not become aware until the condition becomes apparent through diagnostic testing for other symptoms or conditions. However, if a rolling hiatal hernia is discovered, it is important to pay attention to the potentially asymptomatic condition, because it does possess a higher risk for serious complications.

There are two main hiatal hernia types, sliding and rolling. Most people have the first type and suffer from a small, sliding hiatal hernia. This particular type of hiatal hernia refers to a part of the stomach that has slipped through or been pushed through the opening in the diaphragm that is called the hiatus. This piece of stomach, which is also the point where the stomach and esophagus meet, appears as a bulge sitting atop the diaphragm, with the esophagus jutting upward. A rolling hiatal hernia is different in that while the same part of the stomach becomes pushed through the same opening, instead of it remaining below the esophagus, it actually ends up rolling up along its side and appears as an elongated bulge next to the esophagus.

Both types may display the same hiatal hernia pain symptoms, although it is possible that people with the more serious rolling hiatal hernia may experience them more often. Some people with small, sliding hiatal hernias experience no symptoms. This might be the case in persons with a paraesophageal hiatal hernia as well, although it is more likely that someone with a paraesophageal hernia will experience unpleasant symptoms. The pain itself most often does not come from the hernia, rather as a result of it. When the sphincter that keeps stomach acid from entering the esophagus moves or is shifted on its angle, it might let stomach acid move more freely into the esophagus. Unlike the stomach, which is well lined to protect itself from volatile bodily acids, the esophagus has no such protection and quickly becomes irritated or inflamed when it is present. This acid reflux is what accounts for the majority of hiatal hernia pain symptoms which can include in addition to the pain, coughing, belching and difficulty swallowing.

The only way to differentiate between a sliding or small hiatal hernia and one that runs parallel to the esophagus is with diagnostic testing. Sometimes, a rolling hiatal hernia is discovered accidentally while other routine testing is being done. Other times, symptoms related to reflux may be persistent, which can indicate the presence of a hiatal hernia. Usually, a barium swallow x ray is used to provide a hiatal hernia diagnosis, and interestingly enough, this test is better at identifying rolling hiatal hernia than it is the sliding form of the condition. Other tests for diagnosis include ultrasounds, CT scans and endoscopic procedures.

Regardless of type, treatment for hiatal hernia symptoms often revolves around reducing the amount of acid that is in the stomach in order to prevent it from backing up. Medications are used in this purpose including proton pump inhibitors and H2 receptor blockers. Dietary changes including eliminating trigger foods and replacing them with low acid foods can also be beneficial, and there are some lifestyle changes that can bring relief as well. However, while treatment for hiatal hernia symptom relief might not vary much between the two types, monitoring does become more important in the case of a rolling hiatal hernia, as it is more likely to lead to complications.

Strangulated hiatal hernias are uncommon but are very serious. They occur when the blood supply to the herniated tissue has its blood supply cut off. It is considered a serious medical emergency and surgery is the only form of accepted treatment. Not all rolling hiatal hernias will become strangulated, but they are more likely to do so than sliding hernias. Unfortunately, the symptoms of strangulation are most commonly more severe cases of existing hiatal hernia symptoms, with sudden, intense chest pain being the most common. Shortness of breath may also occur, and these are both signs that urgent medical attention is needed.

A rolling hiatal hernia is rarely cause for concern and its symptoms, if present, are often easily treated. It is a less common type of hiatal hernia, and is more likely to lead to complications. Regular medical monitoring and advice are essential to managing the condition and reducing the risk of worsening symptoms or potentially serious consequences.