Treatment of hiatal hernia (gastroesophageal hernia) in Germany

Hiatal hernia occurs when the abdominal part of the esophagus and other organs (stomach, small intestine, omentum) protrude into the chest cavity. This pathology is met in 0,5% of population.


Gastroesophageal hernia requires surgical treatment. Refusal of the treatment leads to the increased risk of developing esophageal cancer.


Hiatal hernia


Causes of hiatal hernia (gastroesophageal hernia)

Abdominal and thoracic cavities are separated by a barrier calleddiaphragm. Diaphragm has several gaps including the esophageal hole. Esophagus passes from thoracic cavity into the abdominal cavity through this hole.


If the diaphragm stops to hold an esophagus, it moves up because pressure is in the abdominal cavity is higher than in thoracic cavity. That’s how hiatal hernia develops. Hernia is a protrusion of the abdominal part of the esophagus and stomach fragment into the chest thoracic cavity. Less often, small intestine loops and omentum also moves away.


Causes of hernia causes:

  • High intra-abdominal pressure
  • Reduction of anatomical structures strength that fixes the stomach and the esophagus into the abdominal cavity
  • Displacement of the esophagus due to its up retractions from the chest cavity


Intra-abdominal pressure might go up because of:

  • Obesity
  • Intense physical stress
  • Pregnancy
  • Non-stop vomiting
  • Severe cough
  • Ascites (fluid accumulation in the abdomen)
  • Oncological processes


Weakening of the connective tissue structures that fix the esophagus can appear due to:

  • Age involution
  • Congenital abnormalities
  • Abnormal metabolic processes
  • Asthenic (lean) body type


Esophagus can not only be pushed up from the abdominal cavity, but it can also sometimes be pulled from the thoracic cavity. It happens due to a number of reasons:

  • Short esophagus
  • Peptic ulcer
  • Chemical or thermal burns
  • Esophagus traumas with scarring


Hernia types


Hernia types

There are three hiatal hernia types: axial (sliding), paraesophageal, and mixed. In the first case, the abdominal part of the esophagus and an adjacent part of stomach move freely into the chest cavity and come back when body position changes. This is the most common hiatal hernia.


While having paraesophageal hernia, a part of stomach goes up and locates directly next to the chest section of esophagus.


There are three stages of hiatal hernia severity:

  • Stage 1 is when only abdominal esophagus section enters the thoracic cavity
  • Stage 2 is defined when cardiac orifice enters thoracic cavity and stomach part is located directly next to the esophageal opening
  • Stage 3 occurs when stomach part goes higher than diaphragm level


There are fixed and unfixed hiatal hernias. Unfixed hernia appears from time to time depending on the patient’s body position.


Hiatal hernia symptoms


Hiatal hernia symptoms

Hiatal hernia is asymptomatic in about half of cases. Other half report pain and heartburn as basic symptoms.


Pain characteristics for hiatal hernia:

  • It is located in the epigastric region
  • It spreads along the esophagus
  • Its intensity can be low or mild
  • Pain is dull and aching
  • 20% of patients tell about pain irradiation into the heart
  • Pain occurs only after a meal
  • Painful sensations strengthen when a person bends forward and in horizontal position
  • Physical activity strengthens the pain
  • Hiccups or burps weaken pain
  • Pain decreases in vertical position


Hiatal hernia leads to the cardiac orificeclosing process (it’s a place where esophagus enters the stomach). As a result, stomach contentgets into the esophagus irritating its walls. Then heartburn, burps, regurgitation of food occurs.


Lots of patients complain about burning pain behind the breastbone and it is often confused with heart pain.


Hiatal hernia diagnostics


Hiatal hernia (gastroesophageal hernia) - Diagnostics

In the majority of cases, hiatal hernia is easily diagnosed with the help of radiography. The picture is done in horizontal position. Method sensitivity is 94%.


To increased radiography sensitivity use of following is applied:

  • Contrasting agent injection
  • Use of the poses when intra-abdominal pressure is increased
  • Injection of medicines (atropine, neostigmine) to low the digestive tract organs tone


Endoscopic diagnostic methods are more informative. A doctor examines the esophagus and the stomach using a tube with a camera. He can detect not only hernia, but also can evaluate condition of the mucous membrane of the esophagus,  identify possible complications, and take biopsy for histology analysis.


Hiatal hernia treatment abroad


Treatment of hiatal hernia (gastroesophageal hernia) abroad

Hiatal hernia can be treated conservatively as well as with surgery. Prescription of medicines or some other conservative treatment methods doesn’t cure the illness, but it facilitates its flow and reduces the risk of complications.


Drug therapy includes the prescription of medicines that will normalize motility of the gastrointestinal tract and relieve heartburn.


Surgery is the basis of the treatment. It helps to remove the hiatal hernia once and forever. Depending on the clinical course, different types of surgeries are done:

  • Hernia repair (hernioplasty) is a herniorrhaphy with esophageal diaphragmatic ligament strengthening
  • Gastropexy is a fixation of a stomach
  • Fundoplicationis a restoration of an acute angle between the abdominal section of esophagus and fundus


Untreated hiatal hernia can be accompanied by multiple complications:

  • Reflux esophagitis
  • Peptic ulcer
  • Esophagus obstruction
  • Intussusception of the esophagus into the stomach
  • Acute bleeding
  • Prolapse of the gastric mucosa in the esophagus
  • Perforation (perforation, rupture) of the esophagus
  • Strangulated hernia


Complications are treated conservatively and surgically. Some of them require emergency surgical help.


Hiatal hernia prognosis


Hiatal hernia (gastroesophageal hernia) - Prognosis

Untreated hiatal hernia leads to the reflux esophagitis progression that leads to peptic esophagus ulcer as a result. Peptic ulcer is a precancerous condition. Patients who don’t treat hernia have the risk of cancer increased by 3 times in 6 years and by 5 times in 12 years.


Prognosis is favourable after the surgical treatment. Hiatal hernia symptoms, including heartburn, completely disappear. Risk of recurrence is low and post-surgery complications are rarely met.



Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.

The program includes the following:

  • Issuing of an invitation for getting a visa for treatment as quick as possible
  • Fixing an appointment at a time convenient for you
  • Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
  • Arranging transfer from the airport to the hospital and back to the airport
  • Provision of interpreting services and services of a personal medical coordinator
  • If necessary, assistance in the organization of further surgical treatment
  • Provision of a medical insurance against treatment complications covering up to 200,000 euro
  • Preparation and translation of medical records and recommendations from the hospital
  • Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc

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