Hiatal Hernia and Weight Loss 

Dr. Christopher McGowan
November 6, 2023

Having a hiatal hernia is a somewhat common occurrence in the United States, with about 20% of the population affected at some point in their lives. It is a much more common occurrence in people over the age of 50, though, and it can unfortunately cause some painful and uncomfortable symptoms. For those with severe cases, surgery may be the only option for long term relief. Even though hiatal hernia surgery does carry some inherent risks, however, the surgery has one potential side effect that is worthy of note: weight loss.

What is a Hiatal Hernia?      

Hernia is the term for when tissue or an organ have abnormally pushed through the barrier of the cavity in which they reside. In the case of a hiatal hernia, this means that an abdominal organ has pushed through an opening (technically known as a hiatus) in the diaphragm, the large dome-shaped muscle that separates the abdominal cavity from the chest cavity. Most of the time it is the stomach that pushes through, and there are two main types of hiatal hernias:

  • Sliding: A sliding hiatal hernia is the more common of the two types, and it involves the junction of the esophagus and stomach sliding up into the chest through the hiatus. Since the whole junction slides up somewhat uniformly, the hernia tends to be smaller and may not even cause symptoms.
  • Paraesophageal: A paraesophageal hernia involves a portion of the stomach pushing out through the hiatus next to the esophagus; in other words, the junction remains in place but a part of the stomach bulges up alongside the esophagus. This type is less common, but it tends to be more problematic for the patient.

Symptoms of Hiatal Hernia

Approximately 90-95% of hiatal hernias are the sliding type, and most of the time there are either no symptoms or a few minor symptoms; the other 5-10% are paraesophageal, and of those cases, about half are asymptomatic. When symptoms do present, they can vary in severity from person to person. Below are some common symptoms of hiatal hernia:

  • Heartburn: Technically known as acid reflux, heartburn is the most common symptom of a hiatal hernia. Because the gastroesophageal junction has been pushed through the diaphragm, it can negatively affect the function of the lower esophageal sphincter, the ring of muscle that keeps stomach contents from backing up into the esophagus. When stomach acid sloshes up into the esophagus, it can cause inflammation (esophagitis) and can even potentially damage the tissue. If left untreated, it can become chronic and turn into gastroesophageal reflux disease (GERD).
  • Dysphagia: Dysphagia is the term for having difficulty swallowing, which can happen if the hernia is large enough to obstruct the passage of food from the esophagus into the stomach.
  • Regurgitation: Regurgitation is the involuntary return of partially digested food from the stomach to the mouth. While this is possible with regular acid reflux, it is more likely with a hiatal hernia because part of the stomach gets squeezed. Regurgitation may also be accompanied by a sour or bitter taste in the mouth.
  • Pain: People with hiatal hernias can also experience chest pain that may eerily feel like something more serious; however, this is due to acid reflux and not a problem with the heart or lungs.
  • Belching: The nature of how a hiatal hernia affects the upper part of the digestive system can lead to excess gas being trapped in the stomach when eating and drinking. This gas then tends to escape back up through the esophagus in the form of belching.
  • Other: The impact of a hiatal hernia on the digestive system can also cause additional gastrointestinal symptoms like indigestion, constipation, and a feeling of fullness or abdominal pressure.

What Causes a Hiatal Hernia? 

The precise cause of hiatal hernias is not currently known, though there are some people with a congenital predisposition to have an abnormally large hiatus. Despite some of the uncertainty about the cause, there are some risk factors that have been identified:

  • Age: Age is perhaps the biggest risk factor for a hiatal hernia, in large part because of the natural weakening and degradation of muscles and tissues throughout the body. The diaphragm, for instance, gets weaker as we age, and it becomes easier for stomach tissue to squeeze through the opening of the hiatus.
  • Trauma: Injuries to the area, such as blunt force trauma, can lead to the development of a hiatal hernia. There are also some less intense situations and movements that can similarly put pressure on the abdomen; examples include heavy lifting, frequent hard coughing or sneezing, and straining during defecation.
  • Obesity: There has long been a connection between obesity and hiatal hernias because obese patients carry a lot of weight around the midsection that exerts pressure on the entire abdominal cavity. Pregnant women are at a similar risk because of the pressure of the growing fetus on the abdomen.
  • Smoking: Smoking may contribute to weakening of the lower esophageal sphincter as well as cause intense coughing; both are likely to increase the chances of a hiatal hernia.

Weight Loss After Hiatal Hernia Repair  

As noted, most people with a hiatal hernia won’t experience symptoms and therefore won’t require any kind of treatment. For those who do have symptoms, the treatment options will vary based on the severity of the condition and the nature of the symptoms. Lifestyle changes (like sleeping with the head of your bed elevated) and over-the-counter antacids can help ease the symptoms for most people, but for others surgery may be necessary. The surgery, known as fundoplication, is the same laparoscopic surgery used to treat GERD.

The fundoplication surgery involves wrapping the top of the stomach known as the fundus around the lower esophagus to create a valve-like structure. This wrap, which can be partial (360 degrees) or complete (270 degrees), reinforces the lower esophageal sphincter and helps prevent stomach acid from refluxing into the esophagus. This is the most common procedure for the treatment of GERD and hiatal hernia, though occasionally the relief doesn’t last and the procedure needs to be performed again.

In addition to relieving the symptoms related to a hiatal hernia, the surgery may also have the unintended side effect of promoting weight loss. While weight loss isn’t the goal of the procedure, the overall reduction in symptoms related to eating may promote a more regular and varied diet that is healthier and more likely to lead to a calorie deficit. There is also a possibility of having at least a temporarily reduced appetite in the days and weeks following the surgery.

Reliable Weight Loss Solutions 

Even though weight loss may be an unexpected benefit of hiatal hernia surgery, it’s likely to be minimal and temporary. To really achieve the kind of long-term weight loss most people are looking for, a comprehensive approach is needed that is specifically designed to aid weight loss. Yet while traditional methods like adopting a restrictive diet or exercise plan get a lot of attention online, they aren’t actually very effective and typically lead to a pattern of losing weight and then gaining it back again.

If you, like many Americans, are tired of trying the same old solutions for weight loss, then it’s time to consider a new approach. At True You Weight Loss, we offer endobariatric weight loss procedures that can lead to results that are comparable to bariatric surgery options like gastric bypass without the risks of actual surgery. To learn more about endoscopic sleeve gastroplasty or any of our other state-of-the-art procedures, please contact us today to request a consultation.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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