Hiatal Hernia Symptoms and Treatment

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A hiatal hernia is an abnormality in the stomach whereby part of the stomach protrudes through the diaphragm and up into the chest. These types of hernias are actually present in around 15% of the population although only a small amount of patients will have any symptoms. There are two different types of hiatal hernias, one of which is a sliding hernia whereby the hernia moves when you swallow, and a para-esophageal hernia which stays in a constant position even when you swallow.

What is A Hiatal Hernia?

In normal individuals, the esophagus passes down through the chest, across the diaphragm and into the abdomen through a hole called the esophageal hiatus. The esophagus then joins the stomach just below the diaphragm. In individuals with hiatal hernias, the esophageal hiatus is larger than normal and a portion of the stomach slips through this gap, causing it to protrude into the chest.

What Causes A Hiatal Hernia?

It’s thought that hiatal hernias are primarily caused by having a larger than usual esophageal hiatus, whereby the stomach can slip through the hiatus and protrude into the chest. It is also thought that having a shorter esophagus, perhaps through scarring and inflammation through acid reflux could cause a hiatal hernia by pulling the stomach up. Another contributing factor could be having an abnormally loose attachment of the esophagus to the diaphragm, which allows the esophagus as well as the stomach to escape upwards.

Symptoms of Hiatal Hernias

Hiatal hernia has been called the “great mimic” because it displays a lot of symptoms that can be misjudged as another disease. Heartburn caused by the disease can be mistaken as a heart attack, while the stomach pains can be thought as excessive acidity. Nonetheless, an individual should be knowledgeable regarding the different symptoms and causes of hiatal hernia, especially if he already has history of other digestive problems.

There are two types of hiatal hernia: sliding and rolling.  Most hiatal hernias are of the sliding type, which is when the hernia only occurs when you swallow due to the muscles of the esophagus pulling up the stomach. It is rare for this type of hernia to present with symptoms. However, when these hernias do prevent with symptoms, the symptoms are usually that of gastro-esophageal reflux disease or GERD. This is because the hernia interferes with the barrier that usually prevents acid from moving from the stomach to the esophagus. Patients with GERD are known to have a much higher chance of developing a hiatal hernia than those who do not suffer with GERD, so it is thought that having gastro-esophageal reflux disease does contribute to the development of a hiatal hernia.

On the other hand, rolling hiatal hernia happens when only the stomach moves up past the diaphragm and covers the side of the esophagus. This is the form of hiatal hernia that exhibits symptoms similar to that of GERD or acid reflux.  Symptoms of GERD include nausea, vomiting, pain after eating, stomach pain and bloating and regurgitation. GERD symptoms may also fluctuate during the night.

Chest pains, heartburn, acid reflux, coughing, belching, burping, hiccups, abdominal pain, and difficulty swallowing are some of the clear symptoms of hiatal hernia. It is closely associated with GERD because many patients of GERD are also diagnosed with the hernia. However, it is not clear whether GERD is a cause of the disease or vice versa. The only conclusive fact is that there is a great tendency of an individual with hiatal hernia to have GERD as well, but GERD can occur without the presence of the said disease.

How Are Hiatal Hernias Diagnosed?

Usually, a hiatal hernia will be diagnosed with an upper gastrointestinal x-ray or an endoscopy. These tests are usually carried out due to symptoms, such as pain in the upper part of the abdomen. The hernia will appear as a separate sac on both the x-ray and endoscopy tests, meaning that it is easy to diagnose. However, this sac may only appear if the individual swallows.

How Are Hiatal Hernias Treated?

The treatment of hiatal hernias depends on which type of hernia the individual is suffering with. Para-esophageal hernias are treated with surgery. The stomach is pulled back down into the abdomen and the esophageal hiatus is made smaller to prevent the stomach from slipping through again. The esophagus is also firmly attached to the diaphragm. Although this is a lengthy surgery, because it returns the anatomy back to normal, it is usually very successful.

Sliding hernias rarely cause major problems – they usually just cause symptoms of acid reflux, so treatment of this type of hernia usually involves similar treatment to that of GERD. If GERD symptoms are particularly severe or they are unresponsive to treatment, surgery may be required to remove the hernia. The surgery will usually be performed in the same way as if the doctor was treating a para-esophageal hernia

Because hiatal hernia is the movement of the stomach upwards past the diaphragm, some of the most important lifestyle changes that should be performed by an individual who experiences it are related to abdominal activity or movement. Wearing tight clothes is very unadvisable as it can push the stomach upward, as well as other activities that can create pressure on the abdomen like bending the torso, carrying heavy loads, and the like. It is also advisable to lose weight if you are overweight, as the excessive fats on the abdomen can also put pressure on the abdomen.

Aside from those, other methods of treating the disease are similar to those done for acid reflux or GERD. These include avoiding eating acidic foods like dairy products, caffeinated foods and beverages, carbonated drinks, pasta, bread, tomatoes, tomato-based foods, oily foods, and fatty foods. Sleeping with the head elevated is a good way of preventing the symptoms of hiatal hernia at night. Avoid lying down or sleeping immediately after eating so that the stomach will not be forced to move in an upward direction. Maintain an upright position to keep the stomach downward, avoiding the rise of stomach acids as well as the discomfort of the disease’s effects. You should also eat in smaller meals more frequently instead of eating large meals at longer periods.

If you are experiencing the symptoms of hiatal hernia but are unsure whether it is GERD or the disease, it is important that you visit a medical professional in order to be diagnosed properly. The medications for the two digestive problems are quite the same, but the approaches in treating them are different. If severe, there may be more adverse methods of treatment done to correct hiatal hernia such as surgical procedures. We should always be conscious about our health so that we will be able to immediately recognize any medical problems that we may be experiencing.