Hiatal Hernia

1 What is Hiatal Hernia?

A hiatial hernia is a condition in which part of the stomach pushes through the diaphragm.

The diaphragm has a small opening through which the esophagus passes on its way connect with the stomach. In hiatial hernia the stomach can push through this opening to enter the thoracic cavity.

Most people with hiatial hernia may not experience any symptoms and may never know they have this condition.

In cases of a large hiatal hernia, food and acid from the stomach can move upwards into the esophagus. This leads to heartburn.

In such cases self-care measures, medications or even surgery may be required.

2 Symptoms

Most people with small hiatial hernias may not experience an symptoms.

Signs and symptoms of larger hiatial hernia include:

3 Causes

The exact cause of many hiatal hernias isn't known.

The diaphragm is a large, dome-shaped muscle that seperates the thoracic cavity from the abdominal cavity. It has a small opening-hiatus, through which the esophagus passes from the thorax to the abdomen to connect with the stomach.

A hiatal hernia occurs as a result of weakening of muscles surrounding the hiatus which leads to the stomach protruding through the diaphragm. The exact reason as to why this happens is not understood.

Researchers believe that age-related changes and pressure on the stomach may contribute to the development of this condition.

Possible causes of hiatal hernia include:  

  • Injury to the area  
  • Being born with an enlarges hiatus
  • Constant and intense pressure on the surrounding muscles, such as coughing, vomiting or straining during a bowel movement or when lifting heavy objects                                          

4 Making a Diagnosis

Hiatal hernias are mostly diagnosed during tests to determine the cause of heartburn or chest oe upper abdominal pain.

Tests or procedures used include:

  • An esophagram (barium swallow)- in which a patient is asked to drink a chalky liquid containing barium that coats the upper digestive tract. This provides a clear silhouette of the esophagus, stomach and upper part of the intestines (duodenum) on X-ray.
  • Endoscopy exam in which a small tube with a light and video camera at one end is inserted into the esophagus and stomach through the mouth to check for any signs of inflammation.
  • Manometry - a thin pressure-sensitive tube (catheter) is passed through the nose, down into the esophagus and stomach to measure the pressure and movement inside the esophagus.

5 Treatment

Treatments for hiartal hernia include medications and surgery.

Medications

Mediactions that can be used  for heartburn and acid reflux include:

  • Over-the-counter antacids, such as Gelusil, Maalox,Mylanta, Rolaids and talums which neutralize stomach acid and provide quick relief.
  • H-2-receptor blockers, such as cimetidine (Tagamet HB), famotidine (Pepacid AC), nizatidine (Axid AR) and ranitidine (Zantac 75), which reduce the production of acid in the stomach.
  • Proton pump inhibitors, such as lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC), which block the production of acid and allow the damaged tissue in the esophagus to heal.

Surgery

Surgery may be required in emergecy situations and for people who are unresponsive to medications to relieve heartburn and acid reflux.

Surgery may involve pulling the stomach into the abdominal cavity and making the hiatus smaller, reconstructing a weak esophageal sphincter or removing the hernia sack.

Surgery can be done through an incision in the chest (thoracotomy or abdomen (laparotomy)).

Laparoscopic surgery, where a small tiny camera and surgical tools are inserted into small incisions made on the abdomen, can be used.

The surgeon can view the inside of the body on a large monitor while performing the operation.

6 Alternative and Homeopathic Remedies

Consult with your physician before starting any alternative and homeopathic remedies for hiatal hernia.

Sometimes practitioners may use their hands to apply pressure to the abdomen in order to move the stomach back into its normal position.

There is no evidence to show that such practices can cure hiatal hernia and no clinical trials have been conducted.

7 Lifestyle and Coping

Lifestyle modifications are necessary in order to manage the symptoms of hiatal hernia.

The following may help patients to control heartburn and acid reflux.  

  • Eating several small meals throughout the day as opposed to a few large meals.
  • Avoiding food that trigger heart burn, such as chocolate, citrus fruits, tomato-based foods, onions and spicy foods.
  • Avoiding alcohol consumption.
  • Eating at least two to three hours before bedtime.
  • Losing weight for obese and overweight people.
  • Quit smoking.
  • Elavating the head of the bed 6 inches ( approximatly 5 centimeters).                                                                                                      

8 Risks and Complications

People who are older than 50 and obese are in risk group of having hiatal hernias.

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