A Hiatal Hernia is a condition in which the upper part of the stomach
moves up into the chest. This happens through a small opening in the diaphragm.
The diaphragm is the muscular wall that separates the abdominal cavity from the
chest cavity.
The different types of Hiatal Hernias include:
Sliding Hiatal Hernia – the herniated part of the stomach slides back and
forth, into and out of the chest
Fixated Hiatal Hernia – the upper part of the stomach is caught up in the
chest
Complicated Hiatal Hernia – several other types of herniation may be seen
in the stomach. These are uncommon but more serious and may require surgery.
Causes
The cause of Hiatal Hernia is unknown. It may result from a weakening of the supportive tissues.
Risk Factors
A risk factor is something that increases your chance of getting a disease or
condition.
- Age: 50 or older
- Obesity
- Smoking
- Pregnancy
- Abdominal injury
- Increased pressure in the abdomen from:
- Severe coughing
- Vomiting
- Straining
- Sudden physical exertion such as weight lifting
Symptoms
Many people with
Hiatal Hernia have no symptoms. Symptoms may occur
when stomach acid moves up into the esophagus. This is known as gastroesophageal
reflux disease (GERD) and can cause:
- Heartburn, especially after eating or lying down
- Pain or discomfort in the stomach or esophagus
- Belching
- Hoarseness
- Chest pain
- Difficulty swallowing
- Bleeding from the stomach or esophagus
Diagnosis
Because they often have no symptoms,
Hiatal Hernia are frequently
detected during a visit to the doctor for another ailments. A hiatal hernia is
usually diagnosed with the following tests:
Upper GI Series – a series of x-rays of the upper digestive system taken
after drinking a barium solution (also called barium swallow)
Biopsy – removal of a sample of tissue to check for complications of GERD,
including:
- Inflammation
- Scar tissue
- Abnormal cells called Barrett's esophagus that can lead to cancer
Treatment
Hiatal Hernia are usually treated only when there are symptoms. When
GERD is present, the following measures may help:
Weight Loss
For people who are obese, losing weight may relieve symptoms.
Dietary Changes
Avoid foods that can relax the muscle that controls the opening between the
esophagus and the stomach including:
- Chocolate
- Peppermint
- Fatty foods
- Coffee
- Alcoholic beverages
Avoid foods and beverages that can irritate the internal lining of the
esophagus, such as:
- Caffeine
- Citrus fruits and juices
- Tomato products
- Pepper
Changes in Size and Timing of Meals
Consuming small meals 4-6 times a day can minimize acid reflux. Avoid drinking
large amounts of fluids with meals. Do not eat within 2-3 hours of bedtime.
Smoking Cessation
If you smoke, stop. It weakens the lower esophageal sphincter.
Reduce Pressure on Your Abdomen
- Wear clothes and belts that are loose around your waist.
- Avoid stooping or bending, which puts increased pressure on the abdomen.
Elevation
Elevating the head of the bed on 6-inch blocks or sleeping on a specially
designed wedge reduces heartburn. This position helps prevent stomach contents
from refluxing backward into the esophagus.
Antacids
Antacids can neutralize acid and temporarily relieve heartburn.
Prescription Medications
For chronic reflux and heartburn, several types of medications may be prescribed
to reduce acid in the stomach. These include:
- H2 blockers such as:
- Cimetidine
- Famotidine
- Nizatidine
- Ranitidine
- Proton pump inhibitors such as:
- Omeprazole
- Lansoprazole
- Pantoprazole
- Rabeprazole
Surgery
Surgery may be needed if:
- You have severe GERD that doesn't respond to other treatments
- The hernia is at risk for twisting, which could cut off the blood supply
to part of the stomach and cause that part to die
Prevention
The following strategies may help to prevent a
Hiatal Hernia:
- Maintain a healthy weight.
- If you smoke, quit.
- Seek medical care for prolonged or severe coughing or straining to pass
stools or urine.