Hiatal hernia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 14, 2016
StartDiseasesHiatal hernia

Sometimes a part of the human body shifts or moves into a spot that is not its normal position. This part is then called a hernia. One of the most common hernias that a person can suffer is a hiatal hernia. Easy to diagnose and treat, a hiatal hernia (also called a hiatus hernia) can be frightening since it mimics other conditions.

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Definition & Facts

In a hiatal hernia, part of the stomach pushes or is pulled up through the small opening between the stomach and the esophagus (food tube). This small hole is called the hiatus and it is located in the diaphragm, a large muscle. When the stomach is pulled up into the esophagus, food and stomach acid may be pulled up as well, resulting in heartburn and pain. For most people, this is a minor but scary condition, since it can produce symptoms that can be mistaken for a heart attack or other conditions.

Symptoms & Complaints

Most people with hiatal hernias have mild symptoms such as heartburn (also called acid reflux since the stomach acid is burning the esophagus tissue) or belching. When extreme chest pain or abdominal pain and pressure are included, many undiagnosed patients think they may be having a heart attack and go to the emergency room.

Someone with a hiatal hernia may also experience a hard time swallowing certain types of food or feel “overfull,” even after a simple meal or snack. In extreme cases, there may be bleeding inside the gastrointestinal tract that shows up as either bloody vomit or blood in stools (black stools). Individuals suffering these symptoms should see their doctor immediately.

Causes

A hiatal hernia is caused by the weakening of tissue around the hiatus. Reasons for this weakness can vary. Women and those over fifty are more likely to have a hiatal hernia. Other causes can be just having a large hiatus, injury in an accident, eating disorders, and obesity. Pregnant women or those with respiratory illnesses can get a hiatal hernia from severe or constant vomiting or coughing. Even straining to lift a heavy item or to have a bowel movement can cause enough pressure to create a hiatal hernia.

Diagnosis & Tests

If a hiatal hernia is suspected, the individual should contact his or her doctor. The doctor may require some tests to confirm the diagnosis or recommend seeing a gastroenterologist (a specialist in digestive diseases). Blood tests may be conducted to test for anemia (lack of red blood cells) in case there is a loss of blood.

An esophagram (or barium swallow) has the patient drink a white, chalky liquid that will help contrast the esophagus, stomach and upper small intestine tissues in an X-ray so the doctor can see damage caused by the hernia or its severity.

A similar test, the endoscopic examination, also lets the physician see the esophagus and stomach through a small tube inserted in the nose and down the individual’s throat. This tube has both a light and an extremely small camera attached at the end to allow the physician to see the injured area.

Finally, a manometry test may be done. This test is similar to the endoscopy, but this time the tube is pressure-sensitive and is inserted through the nose. The pressure-sensitive tube allows the doctor to check and evaluate the pressure in the feeding tube and the ease with which food can travel down into the stomach. While uncomfortable, these tests are quick, helpful and take little or no recovery time.

Treatment & Therapy

After an individual has been diagnosed with a hiatal hernia, there are many options for treatment. For those with little or no symptoms, or rare heartburn attacks, no treatment may be necessary. Those with simple heartburn may use over-the-counter (OTC) medications such as Maalox®, Mylanta®, Rolaids®, or Tums®.

Other medications may be recommended that take other actions to deal with acid reflux. One group, H-2-receptor blockers work to limit the amount of acid the body produces. These medications may be in OTC medications or stronger doses may be prescribed by a doctor. These include cimetidine, famotidine, nizatidine, and ranitidine.

Another frequently recommended group, the proton-pump inhibitors, are used to severely limit acid production in the body so that the damaged tissue in the esophagus has a chance to heal from previous acid attacks. Like the H-2-receptor blockers, they can be either OTC or prescribed. Lansoprazole and omeprazole are two of the most common proton pump inhibitors.

Finally, there are some cases that can only be addressed by surgical measures, usually in emergency situations. They work by either moving the stomach to a lower location in the abdomen, rebuilding or strengthening a weak esophagus muscle (sphincter), or by removing the part of the stomach that has formed a pouch or sac in the esophagus.

These surgeries are usually done by laparoscopic surgery, meaning that the doctor inserts a tube with a camera into small incisions in the chest or abdomen to see the area and perform the surgery. Usually, a minimum of two or three weeks is required for recovery although there may be lifting restrictions for a time as well.

Prevention & Prophylaxis

Prevention is often the best medicine and hiatal hernias can be easily prevented in most cases. Small lifestyle changes can make a big difference, such as losing weight, stopping the use of tobacco, and limiting the use of alcohol.

Other eating changes include eating small meals throughout the day instead of one, two or three large ones. Try to be sure the last meal is two to three hours before you go to bed. When you eat, try to avoid any foods you suspect cause, or trigger, heartburn or acid reflux, such as spicy foods, chocolate, citrus fruit, onions, or tomato products.

One other tip for reducing heartburn at night is to elevate the top of your bed with pillows, folded blankets or other objects so that your head is at least six inches (fifteen centimeters) higher than your feet. Taking these actions can help prevent pain and discomfort in the future.