Reduction and Resolution of a Hiatal Hernia Using Osteopathic Manipulative Treatment: A Case Report

Hiatal hernia is a condition where components of the abdominal cavity, most often a part of the stomach, penetrate through the diaphragm and into the chest cavity. The symptoms of hiatal hernias may differ secondary to their type and severity. The two main types of hiatal hernias are sliding and paraesophageal. Sliding hernias, which are more common and less of a cause for concern, are when the upper portion of the stomach and junction between the stomach and esophagus slides up into the thoracic cavity through a weakened diaphragm. These hernias account for the majority of all hiatal hernias, and their symptoms mimic those of gastroesophageal reflux disorder (GERD) due to laxity in the lower esophageal sphincter. Paraesophageal hernias occur when parts of the stomach and other abdominal organs protrude through the hiatus adjacent to an intact and in-place esophagus and stomach. Obesity and old age are risk factors for hiatal hernias, but they can occur in patients of any age and gender. Although some hiatal hernias may be asymptomatic, patients with positive symptoms may complain of heartburn, regurgitation of liquids and food back into their mouths, dysphagia, or discomfort and pain in the stomach or esophagus. Hiatal hernias are preferentially diagnosed with proper imaging, mainly with an upper gastrointestinal barium study, or by upper gastrointestinal endoscopy. The treatment for hiatal hernias depends on their severity and surgical repairs, if needed, are mostly done laparoscopically. In this case of a patient with a 3 cm hiatal hernia diagnosed with the help of esophagogastroduodenoscopy (EGD), the treatment did not require surgery. Instead, osteopathic manipulative treatment (OMT) was used to restore the functionality of the gastrointestinal tract and the placement of the gastroesophageal junction. The patient's symptoms were found to have improved after the application of OMT alone, with no symptoms of hiatal hernia and resolution of her somatic dysfunctions. The results of this case study suggest that OMT can be effectively utilized to treat the symptoms of hiatal hernias and may also be effective as a curative method as well.