• Hiatal Hernia

    (Hiatus Hernia)

    Definition

    A hiatal hernia is a condition in which the upper part of the stomach moves up through a small opening in the diaphragm into the chest. 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—This is the most common type. The herniated part of the stomach slides into and out of the chest cavity.
    • Fixed hiatal hernia—The upper part of the stomach remains in the chest cavity.
    • Complicated hiatal hernia—Several other types of stomach herniation may be seen. These are uncommon but more serious and may require surgery.
    Hiatal Hernia
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    Causes

    Many people are born with a hiatal hernia but the cause is still 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.
    Risk factors include:
    • 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

    Most people with hiatal hernias have no symptoms.
    Symptoms may occur when stomach acid moves up into the esophagus (swallowing tube). This is known as gastroesophageal reflux disease (GERD) and can cause:
    • Heartburn, especially after eating or lying down
    • Pain or discomfort in the stomach, chest, or esophagus
    • Belching
    • Hoarseness
    • Throat irritation (frequent clearing of the throat)
    • Chest pain
    • Difficulty swallowing
    • Bleeding from the stomach or esophagus

    Diagnosis

    Because they often have no symptoms, hiatal hernias are sometimes only detected during a visit to the doctor for other 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, to show the outline of the digestive system.
    • Endoscopy—A camera mounted on a thin, lighted tube is inserted through the mouth into the esophagus. The esophagus is your swallowing tube. A biopsy or sample of tissue may be taken to check for any complications, including:

    Treatment

    Hiatal hernias 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
    • Hot peppers
    • Carbonated beverages
    To minimize acid reflux:
    • Consume smaller meals 4-6 times a day versus three large meals.
    • Avoid drinking large amounts of fluids with meals.
    • Do not eat within 2-3 hours of bedtime.

    Smoking Cessation

    If you smoke, quit. Smoking weakens the lower esophageal sphincter, a muscle that controls the opening between the esophagus and the stomach.

    Reduce Pressure on Your Abdomen

    • Wear clothes and belts that are loose around your waist.
    • Avoid stooping or bending after meals, 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
      • Esomeprazole
      • Lansoprazole
      • Pantoprazole
      • Rabeprazole

    Surgery

    Surgery may be needed if:
    • You have severe GERD symptoms that do not 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:

    RESOURCES

    American College of Gastroenterology http://www.acg.gi.org

    National Institutes of Health http://www.nih.gov

    CANADIAN RESOURCES

    Canadian Medical Association http://www.cma.ca

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    References

    DynaMed Editorial Team. Hiatal hernia. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated June 22, 2010. Accessed November 17, 2010.

    Mayo Clinic. Hiatal hernia. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/hiatal-hernia/DS00099. Updated June 2009. Accessed July 10, 2009.

    Revision Information

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