Hiatal Hernia

Information on the causes of hiatal hernias, stomach and esophageal pain.

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  1. What is a Hiatal Hernia?
  2. What Causes a Hiatal Hernia?
  3. Diagnosing a Hiatal Hernia
  4. Help for Hiatal Hernia
  5. More Information on Hiatal Hernia

What is a Hiatal Hernia?

A hiatal hernia is when the upper part of the stomach protrudes into the thorax through a tear or weakness in the diaphragm. While the thought is quite disturbing, it is generally less serious than is sounds and in many cases, there are no symptoms at all.

However, as the stomach pushes up through the opening near the esophagus, it can start to put pressure on valve that divides the esophagus from the stomach and acid reflux and heartburn is often the result, known as a sliding hiatial hernia.

Large hiatal hernias are a common cause of gastroesophageal reflux disease (GERD) and so the symptoms experienced are generally related to GERD. In rare cases, the protruding part of the stomach may become twisted causing severe chest pain, difficulty swallowing and obstruction of the esophagus, known as a rolling hiatus hernia.

Common symptoms of a Hiatal Hernia
  • Heartburn (a burning sensation in the chest which may travel up to the throat)
  • Chest pain, often worse when lying down
  • Belching
  • Nausea
  • Difficulty swallowing (dysphagia)
  • The experience of regurgitating food, or sour liquid

What Causes a Hiatal Hernia?

The abdomen and the chest are separated by a large dome shaped muscle called the diaphragm which plays a significant role in the breathing process. The esophagus (food pipe) passes into the stomach through a small opening in the diaphragm called the hiatus.

A hiatal hernia is caused when this hiatal opening becomes weak, or there is a tear in the connective tissue, and so a part of the stomach moves through the opening and sits above the diaphragm.

The exact cause of why this happens is not fully known, although there are a number of factors that may contribute to the condition. These include:

  • Inherent weakness of the diaphragm, or unusually large hiatal opening
  • Injury
  • Anything that places intense pressure on the abdomen such as pregnancy, straining from constipation, coughing, vomiting, or lifting heavy objects.

Diagnosing a Hiatal Hernia

In most cases a hiatal hernia is discovered when looking for the cause of GERD or recurrent heartburn. A Barium x-ray or an endoscopy are the two tests that are used to make a firm diagnosis.

Help for Hiatal Hernia

In many cases where small hiatal hernias are discovered, no treatment is necessary, unless symptoms are present. When symptoms such as acid reflux occur, you physician may recommend a few over-the-counter and/or prescription medications similar to those medications used to treat GERD.

These may include antacids, such as Maalox, or Tums which may be suggested to neutralize stomach acid and grant quick but temporary relief of symptoms.

H-2-receptor blockers, such as Pepcid AC, and Zantac 75 work by decreasing the amount of acid produced, while Proton pump inhibitors such as Prilosec and Aciphex work by blocking acid production thus giving the damaged esophageal tissue time to heal. In some cases, life-style changes and medication aren’t helping to relieve symptoms, or in severe cases where complications occur, surgery may be necessary.

More Information on Hiatal Hernia

Tips for those suffering from Hiatal Hernias
  • Eat smaller meals more frequently rather than large meals as this will ease the pressure placed on the esophageal valve and reduce acid reflux.
  • Watch what you eat. Some foods relax the esophageal valve making heartburn more likely – these foods include: alcohol; beverages containing caffeine, carbonated beverages; citrus fruits and juices; tomatoes and tomato sauces; chocolate; spicy and fatty foods.
  • Avoid eating late at night or before going to bed. Lying down with a full stomach can cause stomach contents to press harder against the valve, increasing the chances of refluxed food. Make sure you don’t eat anything 3 hours before lying down or going to bed.
  • Try to elevate your head at night, so that gravity helps to keep stomach contents from pressing against the esophageal valve.
  • If you are overweight, try to lose weight naturally. Obesity increases abdominal pressure, which can worsen the hernia and can push stomach contents up into the esophagus making symptoms worse.
  • Don’t wear clothes that are too tight around the waist. This will squeeze the stomach, forcing food up against the esophageal valve, and increase the likelihood of reflux.
  • Stop smoking naturally. The chemicals in cigarette smoke weaken the muscles as they pass from the lungs into the blood.
  • Avoid alcohol. Alcohol not only relaxes the lower esophageal valve (allowing the reflux of stomach contents into the esophagus) but also increases the production of stomach acid.
  • Learn to relax. Stress causes a delay in digestion and as a result the stomach empties slower making symptoms worse. Try deep breathing and muscle relaxation techniques or take up yoga.


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