Hiatal Hernia
A hiatal hernia occurs when the upper part of the stomach pushes through an opening in the diaphragm and into the chest cavity. The diaphragm is the thin muscle wall that separates the chest cavity from the abdomen. The opening in the diaphragm is where the esophagus and stomach join.
Causes
The most common cause of a hiatal hernia is an increase in pressure in the abdominal cavity. Your abdominal cavity is the space in the middle of your body that holds several organs, including the:
Lower part of the esophagus and stomach.
Small intestine, colon and rectum.
Liver.
Gallbladder, pancreas and spleen.
Kidneys.
Bladder.
This pressure can build up from things like:
Coughing.
Vomiting.
Straining during a bowel movement.
Heavy lifting.
Physical strain.
Risk factors
A hiatal hernia can develop in people of all ages and both sexes, although it frequently occurs in people aged 50 and older. Hiatal hernia occurs more often in people with overweight/obesity and smokers.
Symptoms
Many people with a hiatal hernia never have symptoms. Some people with hiatal hernia have some of the same symptoms as gastroesophageal reflex disease (GERD). GERD occurs when digestive juices move from the stomach back into the esophagus. Symptoms of GERD include:
Heartburn.
Bitter or sour taste in the back of the throat.
Bloating and belching.
Discomfort or pain in the stomach or esophagus.
Although there appears to be a link between hiatal hernia and GERD, one condition does not seem to cause the other. Many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.
Diagnosis
A barium swallow involves drinking a special liquid, then taking X-rays to help see problems in the esophagus (such as swallowing disorders) and the stomach (such as ulcers and tumors). It also shows how big the hiatal hernia is and if there is twisting of the stomach as a result of the hernia.
An endoscopy is a procedure in which the inside of the upper digestive system is viewed with an endoscope (a long, thin, flexible instrument about 1/2 inch in diameter).
An esophageal manometry measures the strength and muscle coordination of your esophagus when you swallow.
A pH test measures the acid levels in the esophagus and helps determine which symptoms are related to acid in the esophagus.
Gastric emptying studies examine how fast food leaves the stomach. Results from this test are especially important in patients who have nausea and vomiting. There could be other causes of the nausea and vomiting besides a hiatal hernia.
Treatment
Maintaining a weight that’s healthy for you.
Decreasing the portion sizes of meals.
Avoiding certain acidic foods—such as tomato sauce and citrus fruits or juices—that can irritate the esophageal lining.
Limiting fried and fatty foods, foods or drinks containing caffeine (including chocolate), peppermint, carbonated beverages, alcoholic beverages, ketchup and mustard, and vinegar.
Eating meals at least three to four hours before lying down, and avoiding bedtime snacks.
Keeping your head six inches higher than the rest of your body when lying on your back. Raising the level of your head helps gravity keep your stomach’s contents in the stomach. Raising the head of your bed by angling your mattress works best—piling your pillows doesn’t work as well because it makes you crunch your middle instead of simply angling your body upwards.
Quitting smoking.
Not wearing a tight belt or tight clothing that can increase the pressure on the abdomen such as control top hosiery and body shapers.
Taking medications after eating to reduce acid in the stomach. These over-the-counter medications include antacids, or H-blockers