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What is a hiatal hernia?Introduction

A hiatus hernia, or hiatal hernia, is when part of the stomach squeezes up into the chest through an opening ("hiatus") in the diaphragm.

The diaphragm is a large, thin sheet of muscle between the chest and the abdomen (tummy).

Hiatus hernia and heartburn

A hiatus hernia itself rarely has any noticeable symptoms. However, it can cause a problem called gastro-oesophageal reflux disease (GORD).

GORD is where stomach acid leaks into the oesophagus (the tube that carries food to the stomach). It can occur if a hiatus hernia prevents the valve at the bottom of the oesophagus from working properly.

Your oesophagus can become severely irritated, because it's not protected against stomach acid. This can cause symptoms such as heartburn, chest pain, an unpleasant sour taste in your mouth, and swallowing problems (dysphagia).

You should see your GP if you have frequent and severe symptoms of GORD.

Definition 1-Ahiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region.

The diaphragm is a large muscle that lies between your abdomen and chest. You use this muscle to help you breathe. Normally, your stomach is below the diaphragm, but in people with a hiatal hernia, a portion of the stomach pushes up through the muscle. The opening it moves through is called a hiatus.

This condition mostly occurs in people who are over 50 years old. It affects up to 60 percent of people by the time they’re 60 years old, according to the Esophageal Cancer Awareness Association. Definition 2-A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.

Who's affected

Hiatus hernia can affect anyone, but it's more common in people who are:

over 50 years of age
overweight
pregnant

It's estimated that a third of people over 50 have a hiatus hernia.

There's also a rare type of hiatus hernia that affects newborn babies, which is caused by a congenital defect of the stomach or diaphragm. Congenital means that it is present from birth

What causes a hiatal hernia?The exact cause of many hiatal hernias isn’t known. In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm.

Normally, the space where the esophagus passes through the diaphragm is sealed by the phrenoesophageal membrane, a thin membrane of tissue connecting the esophagus with the diaphragm where the esophagus passes through the diaphragm, so that the chest cavity and abdominal cavity are separated from each other. Because the esophagus shortens and lengthens with each swallow, essentially squeezing food into the stomach, this membrane needs to be elastic to allow the esophagus to move up and down. Normal physiology allows the gastroesophageal (GE) junction, where the esophagus and stomach meet, to move back and forth from just below to just above the diaphragm. However, at rest the GE junction should be located below the diaphragm and in the abdominal cavity. It is important to remember that these distances are very short.

Over time, the phrenoesophageal membrane may weaken, and a part of the stomach may herniate through the membrane and remain above the diaphragm permanently.

Decreased abdominal muscle tone and increased pressure within the abdominal cavity may lead to the development of a hiatal hernia. Thus, peopole who are obese and women who are pregnant are at an increased risk for developing a hiatal hernia.
People who have repetitive vomiting or those who have constipation and strain to have a bowel movement, increase the intra-abdominal pressure when they strain, and this may weaken the phrenoesophageal membrane.
The membrane also may weaken and lose its elasticity as a part of aging.
Ascites, an abnormal collection of fluid in the abdominal cavity often seen in people with liver failure, also is associated with the development of a hiatal hernia.

Picture of Hiatal Hernia

Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:

coughing
vomiting
straining during bowel movements
lifting heavy objects

Some people are also born with an abnormally large hiatus. This makes it easier for the stomach to move through it.

Factors that can increase your risk of a hiatal hernia include:

obesity
aging
smoking

Types of hiatal hernia

There are generally two types of hiatal hernia: sliding hiatal hernias and fixed, or paraesophageal, hernias.

Sliding hiatal hernia

This is the more common type of hiatal hernia. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus. Sliding hernias tend to be small. They usually don’t cause any symptoms. They may not require treatment.

Fixed hiatal hernia

This type of hernia isn’t as common. It’s also known as a paraesophageal hernia.

In a fixed hernia, part of your stomach pushes through your diaphragm and stays there. Most cases are not serious. However, there is a risk that blood flow to your stomach could become blocked. If that happens, it could cause serious damage and is considered a medical emergency

What causes a hiatal hernia?

Normally, the space where the esophagus passes through the diaphragm is sealed by the phrenoesophageal membrane, a thin membrane of tissue connecting the esophagus with the diaphragm where the esophagus passes through the diaphragm, so that the chest cavity and abdominal cavity are separated from each other. Because the esophagus shortens and lengthens with each swallow, essentially squeezing food into the stomach, this membrane needs to be elastic to allow the esophagus to move up and down. Normal physiology allows the gastroesophageal (GE) junction, where the esophagus and stomach meet, to move back and forth from just below to just above the diaphragm. However, at rest the GE junction should be located below the diaphragm and in the abdominal cavity. It is important to remember that these distances are very short.

Over time, the phrenoesophageal membrane may weaken, and a part of the stomach may herniate through the membrane and remain above the diaphragm permanently.

Decreased abdominal muscle tone and increased pressure within the abdominal cavity may lead to the development of a hiatal hernia. Thus, peopole who are obese and women who are pregnant are at an increased risk for developing a hiatal hernia.
People who have repetitive vomiting or those who have constipation and strain to have a bowel movement, increase the intra-abdominal pressure when they strain, and this may weaken the phrenoesophageal membrane.
The membrane also may weaken and lose its elasticity as a part of aging.
Ascites, an abnormal collection of fluid in the abdominal cavity often seen in people with liver failure, also is associated with the development of a hiatal hernia.

Picture of Hiatal Hernia

Symptoms of a hiatal hernia- hiatal hernia causes no symptoms, and most are found incidentally when a person has a chest X-ray or abdominal X-rays (including upper GI series, and CT scans, where the patient swallows barium or another contrast material). It also is found incidentally during gastrointestinal endoscopy of the esophagus, stomach and duodenum (EGD).

Most often if symptoms occur, they are due to gastroesophageal reflux disease (GERD) where the digestive juice containing acid from the stomach moves up into the esophagus.

The stomach is a mixing bowl that allows food and digestive juices to mix together to begin the digestive process. The stomach has a protective lining that prevents acid from eating away at the stomach muscle and causing inflammation. Unfortunately, the esophagus does not have a similar protective lining. Instead it relies on the lower esophageal sphincter (LES) located at the GE junction and the muscle of the diaphragm surrounding the esophagus to act as a valve to prevent acid from refluxing from the stomach into the esophagus. In addition to the LES, the normal location of the GE junction within the abdominal cavity is important in keeping acid where it belongs. There is increased pressure within the abdominal cavity compared to the chest cavity, particularly during inspiration, and the combination of pressure exerted within the lowermost esophagus from the LES, the diaphragm and the abdominal cavity creates a zone of higher pressure that keeps stomach acid in place.

In the situation of a sliding hiatal hernia, the GE junction moves above the diaphragm and into the chest, and the higher pressure zone is lost. Acid is allowed to reflux back into the esophagus causing inflammation of the lining of the esophagus and the symptoms of GERD.

These symptoms may include the following:

heartburn: chest pain or burning,
nausea, vomiting or retching (dry heaves)
burping
waterbrash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid

Symptoms usually are worse after meals. These symptoms may be made worse when lying flat and may resolve with sitting up or walking.

In some patients, reflux into the lower esophagus sets off nervous reflexes that can cause acough or even spasm of the small airways within the lungs (asthma). A few patients may reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing coughing spasms, asthma, or repeated infections of the lung includingpneumonia and bronchitis. This may occur in individuals of all ages, from infants to the elderly.

Most paraesophageal hiatal hernias have no symptoms of reflux because the GE junction remains below the diaphragm, but because of the way the stomach has rotated into the chest, there is the possibility of a gastric volvulus, where the stomach twists upon itself. Fortunately, paraesophageal hernias are relatively uncommon. However, volvulus is a surgical emergency and causes difficult, painful swallowing, chest pain, and vomiting.

It’s rare for even fixed hiatal hernias to cause symptoms. If you do experience any symptoms, they’re usually caused by stomach acid, bile, or air entering your esophagus. Common symptoms include:

heartburn that gets worse when you lean over or lie down
chest pain or epigastric pain
trouble swallowing
belching

Medical emergencies

An obstruction or a strangulated hernia may block blood flow to your stomach. This is considered a medical emergency. Call your doctor right away if:

you feel nauseated
you’ve been vomiting
you can’t pass gas or empty your bowels

Don’t assume that a hiatal hernia is causing your chest pain or discomfort. It could also be a sign of heart problems or peptic ulcers. It’s important to see your doctor. Only testing can find out what is causing your symptoms.

What is the connection between GERD and hiatal hernias?

Gastroesophageal reflux disease (GERD) occurs when the food, liquids, and acid in your stomach end up in your esophagus. This can lead to heartburn or nausea after meals. It’s common for people with a hiatal hernia to have GERD. However, that doesn’t mean either condition always causes the other. You can have a hiatal hernia without GERD or GERD without a hernia.

Testing for and diagnosing hiatal hernias

Several tests can diagnose a hiatal hernia.

Barium X-ray

Your doctor may have you drink a liquid with barium in it before taking an X-ray. This X-ray provides a clear silhouette of your upper digestive tract. The image allows your doctor to see the location of your stomach. If it’s protruding through your diaphragm, you have a hiatal hernia.

Endoscopy

Your doctor may slide a thin tube in your throat and pass it down to your esophagus and stomach. Your doctor will then be able to see if your stomach is pushing through your diaphragm. Any strangulation or obstruction will also be visible.

Hiatal Hernias and Acid Reflux

Overview

A hiatal hernia is a condition in which a small part of your stomach bulges through a hole in your diaphragm. This hole is called a hiatus. It’s a normal, anatomically correct opening that allows your esophagus to connect to your stomach.

The cause of a hiatal hernia is usually unknown. Weak supportive tissues could contribute to the cause. The hernia itself can play a role in the development of both acid reflux and a chronic form of acid reflux called gastroesophageal reflux disease (GERD).

Hiatal hernias require a variety of treatments, ranging from watchful waiting in mild cases to surgery in severe cases.

SymptomsHiatal hernias don’t usually cause symptoms that you’d notice until the protrusion of the stomach through the hiatus is quite large. Small hernias of this kind are most often asymptomatic. You may not be aware of them unless you undergo medical testing for an unrelated condition.

Larger hiatal hernias are big enough to allow undigested food and stomach acids to reflux into your esophagus. This means that you’re likely to display the standard symptoms of GERD. These include:

heartburn
chest pain that intensifies when you bend over or lie down
fatigue
abdominal pain
dysphagia (trouble swallowing)
frequent burping
sore throat

Acid reflux can be caused by a wide variety of underlying factors. Testing may be required to determine if you have a hiatal hernia or other structural abnormality that could be behind your GERD symptoms.

Talk to your doctor about reflux symptoms that don’t get better with lifestyle and diet changes or over-the-counter antacids.

Diagnosis

Imaging tests are used to detect a hiatal hernia and any damage that could have been made by acid reflux. One of the most common imaging tests is the barium swallow X-ray, sometimes called an upper GI or esophagram.

You’ll need to fast for eight hours prior to the test to make sure that the upper portion of your gastrointestinal tract (your esophagus, stomach, and part of your small intestine) is clearly visible on the X-ray.

You’ll drink a barium shake before the test. The shake is a white, chalky substance. The barium makes your organs easier to see on the X-ray as it moves through your intestinal tract.

Endoscopic diagnostic tools are also used to diagnose hiatal hernias. An endoscope (a thin, flexible tube equipped with a small light) is threaded down your throat when you’re under sedation. This allows your doctor to look for inflammation or other factors that may be causing your acid reflux. These factors could include hernias or ulcers

Image result for hiatal hernia ayurvedic treatment

Treatment options for hiatal hernias

Most cases of hiatal hernias don’t require treatment. The presence of symptoms usually determines treatment. If you have acid reflux and heartburn, you may be treated with medications or, if those don’t work, surgery.

Medications

Medications your doctor may prescribe include:

over-the-counter antacids to neutralize stomach acid
over-the-counter or prescription H2-receptor blockers that lower acid production
over-the-counter or prescription proton pump inhibitors to prevent acid production, giving your esophagus time to heal ; Proton pump inhibitor medications are commonly used to decrease acid production. These include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole(Aciphex) and esomeprazole (Nexium).

Surgery

If medications don’t work, you might need surgery on your hiatal hernia. However, surgery is not commonly recommended.

Some types of surgery for this condition include:

rebuilding weak esophageal muscles
putting your stomach back in place and making your hiatus smaller

To perform surgery, doctors either make a standard incision in the chest or abdomen, or use laparoscopic surgery, which shortens recovery time.

Hernias can come back after surgery. You can reduce this risk by:

staying at a healthy weight
getting help lifting heavy objects
avoiding strain on your abdominal muscles

Lifestyle changes

Acid reflux causes most hiatal hernia symptoms. Changing your diet can reduce your symptoms. It may help to eat smaller meals several times a day instead of three large meals. You should also avoid eating meals or snacks within a few hours of going to bed.

Lifestyle changes may include elevating the head of the bed when sleeping to allow gravity to prevent acid from refluxing into the esophagus.
Small frequent meals may help instead of eating two or three larger meals a day.
Some foods that should be avoided include spicy, greasy foods, onions, tomatoes and citrus fruits, however, most individuals are generally aware of the foods that trigger heartburn symptoms and avoid them.

spicy foods
chocolate
foods made with tomatoes
caffeine
onions
citrus fruits
alcohol

Other ways to reduce your symptoms include:

stopping smoking
raising the head of your bed by at least 6 inches
avoiding bending over or lying down after eating
Further problems
It's rare for a hiatus hernia to cause complications, but long-term damage to the oesophagus caused by leaking stomach acid can lead to ulcers, scarring and changes to the cells of the oesophagus, which can increase your risk of oesophageal cancer.

Reducing your risk of hiatal hernias

You may not avoid a hiatal hernia entirely, but you can avoid making a hernia worse by:

losing excess weight
not straining during bowel movements
getting help when lifting heavy objects
avoiding tight belts and certain abdominal exercisesTreatment for a hiatal hernia varies widely and should be tailored to your individual health concerns. Small hernias that show up on diagnostic tests but remain asymptomatic may just need to be watched to make sure that they don’t become large enough to cause discomfort.
Over-the-counter heartburn medications can provide relief from the occasional burning sensation that might stem from a moderately sized hiatal hernia. They can be taken as needed throughout the day in most cases. Calcium and magnesium-based antacids are most commonly stocked in the digestive aids aisle of your local drugstore.
Prescription medications for GERD not only give you relief, some can also help heal the lining of your esophagus from hernia-related acid reflux. These medications are divided into two groups: H2 blockers and proton pump inhibitors (PPI). They include:
- cimetidine (Tagamet)
- esomeprazole (Nexium)
- famotidine (Pepcid)
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- ranitidine (Zantac)
Adjusting your eating and sleeping schedule can also help manage your GERD symptoms when you have a hiatal hernia. Eat small meals throughout the day and avoid foods that trigger heartburn. Foods that can trigger heartburn include:
- tomato products
- citrus products
- greasy food
- chocolate
- peppermint
- caffeine
- alcohol
Try not to lie down for at least three hours after eating to prevent acids from working their way back up your digestive tract. You should also quit smoking. Smoking can increase your risk of acid reflux.
Surgery
Surgery to repair a hiatal hernia may be necessary when drug therapy, diet modifications, and lifestyle adjustments don’t manage symptoms well enough. Ideal candidates for hiatal hernia repair may be those who:
- experience severe heartburn
- have an esophageal stricture (a narrowing of the esophagus due to chronic reflux)
- have severe inflammation of the esophagus
- have pneumonia caused by aspiration of stomach acids
Hernia repair surgery is performed under general anesthetic. Laparoscopic incisions are made in your abdomen, allowing the surgeon to gently push the stomach out from the hiatus and back into its normal position. Stitches tighten up the hiatus and keep the stomach from slipping through the opening again.
Recovery from surgery may range from three to 10 days in the hospital. You’ll receive nutrition through a nasogastric tube for several days post-surgery. Once you are allowed to eat solid foods again make sure you eat small amounts throughout the day. This can help promote healing.
The Female Experience
Women are more likely to get hiatal hernias than men, according toCleveland Clinic. Also, being overweight can increase your risk of developing both GERD and hiatal hernias.

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