Esophageal Hiatal Hernia in Dogs

Dogs, just like humans, can develop hernias. One of these types is a hiatal hernia. This condition isn't among the most common in small animals. Even so, it doesn't hurt to know about it and how to treat it.

At Soyunperro we'll introduce you to what an esophageal hiatal hernia is, how it develops, its symptoms, diagnosis, and the appropriate treatment. Let's get to it.

What Is an Esophageal Hiatal Hernia and How Does It Develop?

Normally and physiologically, between the chest cavity and the abdominal cavity, through the diaphragm, there's an opening: the esophageal hiatus. Through this, the esophagus passes, leaving the chest cavity behind and entering the abdominal cavity.

A hiatal hernia, then, is the movement of the stomach and part of the abdominal esophagus into the chest cavity through the esophageal hiatus. So, these abdominal parts end up herniated, trapped, and causing symptoms. These hernias can be persistent or intermittent.

The possible causes of hiatal hernias are:

• Congenital (present from birth)
• Traumatic
• Gastroesophageal reflux. Reflux can be a cause of hiatal hernias. Chronic reflux (stomach contents constantly rising back up) can eventually cause the abdominal esophagus and part of the stomach to shift into the chest cavity, becoming herniated.

These differ from diaphragmatic hernias in that, in the latter, the abdominal organs enter the chest cavity through an abnormal opening (not the esophageal hiatus) in the diaphragm (usually due to trauma). So, generally, the diaphragm itself is damaged.

Symptoms of a Hiatal Hernia

Symptoms occur from the stomach, or parts of it, being trapped in the esophageal hiatus, making it hard for solid food to pass through. So, we'll have:

• Regurgitation. Undigested food, unable to pass through the stomach since it's trapped, comes back up seconds or minutes after being eaten. It can happen even hours after eating. So, the animal feels uncomfortable after eating.
• Difficulty breathing. Depending on how severe the hernia is and how much content is trapped in the chest cavity, we may observe dyspnea or difficulty breathing. Although this is seen more in diaphragmatic hernias, since the diaphragm is damaged and, therefore, more abdominal organ(s) protrude into the chest cavity.
• Weight loss with polyphagia (desire to eat).
• Dehydration.
• Recurring aspiration pneumonia and/or coughing.

Diagnosis

The vet will need to take a detailed history of the case, along with a complete general physical exam. Next, additional tests such as X-rays will be done. These can be plain or with barium contrast. In both, dilation of the chest esophagus and part of the stomach will be observed; with barium contrast given orally diluted with water, it will "stain" and be better seen on the X-ray. Through esophagoscopy (endoscopy of the esophagus), the area trapped in the esophageal hiatus can be observed from inside the esophagus.

Can a Hiatal Hernia Be Cured? Treatment

Treatment is important, since untreated dogs are prone to developing chronic esophagitis with mucosal ulceration, aspiration pneumonia, further stenosis (narrowing), and strangulation of the abdominal organs.

The prognosis will be guarded in cases of aspiration pneumonia. Treatment can initially be medical, if the vet considers it appropriate, though surgery (depending on how severe the hernia is) will be more definitive.

So, medical treatment involves:

1. Antibiotic therapy, fluids, and electrolytes in patients with pneumonia.
2. Feeding from an elevated position and keeping it that way, as much as possible, for 30 minutes.
3. More liquid food, since this will pass through with somewhat less difficulty.
4. Frequent, small meals.
5. If there's esophagitis, protectants or antacids such as famotidine.

Surgical treatment involves moving the abdominal portions herniated through the esophageal hiatus back into the abdomen and looking for the cause, in case it could herniate again or not. In particular, if coughing or difficulty breathing is observed, contact your vet immediately, since this can indicate aspiration pneumonia secondary to esophageal dysfunction.