Hiatal Hernia

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Hiatal Hernia
(Hiatus Hernia)
Pronounced: High-AY-tal HER-knee-uh
Definition
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.
Hiatal Hernia


The different types of hiatal hernias include:
Sliding Hiatal Hernia – The most common type in which the herniated part of the stomach slides back and forth, into and out of the chest.
Fixed Hiatal Hernia – The upper part of the stomach permanently remains in the chest.
Complicated Hiatal Hernia – Several other types of stomach herniation may be seen. These are uncommon but more serious and may require surgery.
Causes
The cause of hiatal hernia is unknown, and many people are born with it. 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:
o Severe coughing
o Vomiting
o Straining
o Sudden physical exertion (eg, weight-lifting)
Symptoms
Most people with hiatal hernias 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, chest, or esophagus (swallowing tube)
• 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 – This is a series of x-rays of the upper digestive system taken after drinking a barium solution, which lights up 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 or swallowing tube. At this time, a biopsy or sample of tissue may be taken to check for any complications, including:
• Inflammation
• Scar tissue
• Abnormal cells called Barrett's esophagus that can develop into cancer
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
Size and Timing Changes of Meals
Consuming smaller meals 4-6 times a day versus three large meals 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. Smoking weakens the lower esophageal sphincter (the 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:
o Cimetidine
o Famotidine
o Nizatidine
o Ranitidine
• Proton pump inhibitors such as:
o Omeprazole
o Esomeprazole
o Lansoprazole
o Pantoprazole
o 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:
• Maintain a healthy weight.
• If you smoke, quit.
• Seek medical care for prolonged or severe coughing or straining to pass stools or urine.