Hiatal Hernia

What is a hiatal hernia?

Any time an internal part of the body pushes somewhere it does not belong, it is referred to as a hernia. The hiatus is an opening in the diaphragm, (the muscle wall that separates the stomach from the chest) where the hernia is most likely to appear. Typically, the esophagus (food pipe) goes through the hiatus, and fastens to your stomach. With hiatal (hiatus) hernia your stomach will bulge into the chest through this opening. Hiatal hernias are most common in adults fifty and over. The job of the diaphragm is to keep the stomach in the abdominal cavity. When a hiatal hernia occurs, it is much easier for acid to come up. This leaking is also called gastroesophageal reflux (GERD). Hiatal Hernia’s are diagnosed and treated by the GI Division of Premier Medical Group.

What causes a hiatal hernia?

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The cause of hiatal hernia is unknown. Studies show that hernias could be due to a weakening of the supportive tissue. Other possible causes include, age, obesity, pregnancy, smoking, coughing, and straining during bowel movements. It is also possible that a person is born with a large hiatal opening. Though not common in children, the condition is usually something they are born with and occurs with gastroesophageal reflux in infants.

What are the symptoms of a hiatal hernia?

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Generally, a hiatal hernia does not show symptoms. The pain and discomfort a person feels, is usually related to the reflux (GERD) of gastric acid, bile or air buildup. Most common complaints include chest pain, heartburn, and difficulty swallowing. Small hiatal hernias rarely causes problems, and most often people do not even realize they have one. The doctor most often finds it when he is examining you for another condition. When the hernia is larger, it can cause food and acid to back up into your esophagus which would lead to heartburn. This heartburn, left untreated, can lead to a stomach acid backwash in the esophagus which can be painful and cause esophagitis. Esophagitis may lead to esophageal bleeding or ulcers and scarring, which can lead to Barrett’s Esophagus and strictures.

How is a hiatal hernia diagnosed?

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If you suspect that you have a hiatal hernia, your health care provider will begin with a complete physical exam and medical history. Most often, however, a hernia is revealed during an exam or procedure to define the cause of heartburn or chest or upper abdominal pain. These tests include:

  • Barium X-ray: The technician will have your drink chalky liquid containing barium. This will coat your digestive tract, and provide profile of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
  • Endoscopy exam: A thin, flexible tube equipped with a light and video camera (endoscope) is inserted down your throat, esophagus, and stomach to see if there is any inflammation.

What are the types of hiatal hernia?

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The two types of a hiatal hernia are:

  • Sliding hiatal hernias: This is the most common type of hernia. A sliding hiatal hernia happens when the connection of the esophagus and stomach, and part of the stomach protrude into the chest. It can exist permanently in the chest, but often it juts into the chest only during a swallow. When a person swallows, the muscle of the esophagus contracts and causes the esophagus to shorten and to pull up the stomach. The herniated part of the stomach falls back into the abdomen once a person is done swallowing.
  • Para-esophageal hernias: This happens when the gastro-esophageal link does not move, but stays where it belongs (attached at the level of the diaphragm). In this case, a part of the stomach passes or bulges into the chest beside the esophagus. This type of hernia stays in the chest and is not affected by a person swallowing.

How are hiatal hernias treated?

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The objectives of treatment are to relieve symptoms and prevent complications, and in most cases, the treatment does relieve the symptoms. Preventive treatments can include:

  • Medications to neutralize stomach acid
  • Avoiding large meals
  • Reducing obesity
  • Stopping smoking
  • Avoiding lying down or bending over after a heavy meal
  • Avoiding certain foods:
    • Fatty and fried foods
    • Garlic and onions
    • Spicy foods
    • Citrus foods such as lemons, grapefruits, oranges, cranberry juice
    • Beverages such as coffee, tea, alcohol, carbonated beverages
    • Dairy products
    • Oils and butter
    • Tomato based foods
    • Peppermint and spearmint

If preventative measures do not help your symptoms, your doctor may recommend surgery. If the hiatal hernia is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.