Hiatal hernias are classified into four types based on anatomy and severity, each requiring different assessment approaches and management strategies.
| Type | Anatomical Characteristics | Common Symptoms | Considerations |
|---|---|---|---|
| Type I (Sliding Hernia) | Gastroesophageal junction slides up through hiatus; accounts for 95% of cases | Heartburn, acid reflux, regurgitation, chest pain | Often manageable with lifestyle modifications and functional approaches |
| Type II (Paraesophageal) | Stomach fundus herniates beside intact esophagus | Chest pain, early satiety, shortness of breath | Risk of obstruction; may require surgical intervention |
| Type III (Mixed) | Combination of sliding and paraesophageal elements | Variable symptoms combining reflux and mechanical issues | Most complex type requiring comprehensive management approach |
| Type IV (Complex) | Additional organs (colon, spleen, small bowel) herniate into chest | Severe symptoms, respiratory compromise, abdominal pain | Highest risk category requiring immediate specialized care |
Type I Sliding Hiatal Hernias:
Paraesophageal Hernias (Types II-IV):
Systemic and Functional Symptoms:
Comprehensive hiatal hernia evaluation may involve both structural assessment and functional analysis of contributing factors. We are no longer doing endoscopic procedures. We welcome medical records of endoscopies to review for a second opinion. If endoscopy is needed, we have a network of recommended gastroenterologists in the NYC and Miami areas who will perform the procedures and return care to Whole Gut Health for further treatment,
Testing options at Whole Gut Health may include:
We customize diagnostic protocols based on your symptom pattern, hernia type, and overall health status to ensure comprehensive evaluation and optimal treatment planning.
Our Three-Phase Hiatal Hernia Protocol Includes:
1. Assessment and Root-Cause Identification
2. Targeted Intervention
3. Rebuilding and Prevention
Dr. Alexandra Shustina, NYC’s and Miami’s premier gut health specialist doctor is a board-certified gastroenterologist and internist. She is a gut health specialist with training in conventional gastroenterology and functional gut health. She is an expert in the gut microbiome and its role in health and wellness.
At Whole Gut Health, our care is led by experienced functional medicine clinicians with a deep understanding of the gut microbiome and advanced diagnostics. We combine evidence-based strategies from conventional gastroenterology with a functional and integrative lens to give you the clarity and support needed for long-term healing.
A hiatal hernia occurs when part of the stomach protrudes through the diaphragm's hiatus (opening) into the chest cavity. The diaphragm normally separates the abdominal and chest cavities, and when a hernia develops, it can compromise the lower esophageal sphincter function and allow gastric contents to back up into the esophagus, leading to GERD symptoms.
Type I (Sliding Hernia)
Type II (Paraesophageal)
Type III (Mixed)
Type IV (Complex)
Type I Sliding Hernias: Heartburn and acid reflux, regurgitation, chest pain, difficulty swallowing, chronic cough, acidic taste in mouth
Paraesophageal Hernias: Chest pain after eating, feeling of fullness after small meals, shortness of breath, heart palpitations, upper abdominal pain, nausea
Systemic Symptoms: Chronic fatigue from poor sleep, anxiety related to eating, weight loss, iron deficiency anemia, respiratory issues, voice hoarseness
Comprehensive evaluation may involve multiple diagnostic approaches. We welcome endoscopic records for a second opinion and can refer to a trusted network of Gastroenterologists for endoscopic procedures who will return care to Whole Gut Health. The following are done at Whole Gut Health.
Diagnostic protocols are customized based on symptom pattern and hernia type.
Our comprehensive three-phase hiatal hernia protocol includes:
Phase 1: Assessment and Contributing Factor Identification
Phase 2: Targeted Intervention
Phase 3: Long-Term Structural Support and Prevention
Hiatal hernias often result from underlying factors like diaphragm weakness, chronic increased abdominal pressure, and digestive dysfunction. Addressing only the hernia without correcting these factors can lead to recurrence or progression. A comprehensive approach targets root causes for better long-term outcomes.
Many Type I sliding hiatal hernias can be effectively managed with comprehensive functional approaches including visceral manipulation, digestive optimization, diaphragmatic support, lifestyle modifications, and natural anti-inflammatory protocols.
At Whole Gut Health, we take a comprehensive approach that addresses both structural and functional aspects:
Dr. Alexandra Shustina is a board-certified gastroenterologist and internist who serves as NYC's and Miami's premier gut health specialist. She has training in both conventional gastroenterology and functional gut health, with expertise in the gut microbiome and its role in health and wellness.
The first step is scheduling a comprehensive consultation where we'll:
Contact our office to schedule your initial consultation and begin your comprehensive approach to hiatal hernia management and optimal digestive health.
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