6 things to know about hiatal hernias

A hiatal hernia often happens when a part of your stomach pushes up through the diaphragm into the chest area.  The diaghram has a small opening that the food tube or esophagus passes through that connects to your stomach.  A large hiatal hernia causes food and acid to splash up into esophagus causing heartburn, belching, and difficulty swallowing, and, feeling full after meals.  Although hernias aren't incredibly common, there are a few things you'll want to know about them.

1. There Are Two Types of Hiatal Hernias

A sliding hiatal hernia is when the esophagus slides up into the chest through the hiatus opening.  This is the most common type of hiatal hernia. The second is paraesphogael hernia, often called a fixed hernia.  This type causes more problems for patients.  It is when part of the stomach squeezes through the hiatus opening, putting it near the esophagus. Often this type has no symptoms but the danger is that the blood supply to the stomach can be cut off.

Hiatal hernias often cause acid reflux and GERD symptoms, but not everyone with a hiatal hernia gets these diseases.  They are more common in overweight men and women and smokers.  

2. Lots of Things Can Cause Hiatal Hernias

The causes of hiatal hernias are injury to the area or an overly large hiatus. Persistent coughing, vomiting, or straining during a bowel movement is another cause. This condition plays a role in acid reflux and GERD.  When you develop a hiatal hernia you often have symptoms of GERD.  This is a condition that should be treated by a doctor.

3. There Are Many Tests for Hiatal Hernias

Blood tests are given to get a blood count to see if the patient is anemic from blood loss. Another test your doctor may give you is an esphogram barium swallow. During this test the patient drinks a chalky liquid that coats the entire digestive track. That way the doctor can see your esophagus, stomach, and upper part of the small intestine.

 Another test performed is an endoscopy where a tube is passed down the throat with a small light and video camera that checks the esophagus and stomach for inflammation. Manometry is another test used when a small cather like tube is passed through the nose into the stomach and esophagus. It measures movement and pressure in the esophagus.

4. Lifestyle Changes Are Important

When diagnosed with a mild hiatal hernia, lifestyle changes may solve the problem. Even if you have acid reflux or GERD this applies.  You should lose weight and try to maintain a healthy weight for yourself.  Eat moderate to small portions of food and avoid acidic and fatty foods.  Don’t lie down until three to four hours after a meal.  Avoid late night bedtime snacks.  Take over the counter antacids for symptoms.

5. Medications Can Be Used to Treat Hiatal Hernias

In mild cases your doctor will suggest over the counter medications like antacids that provide quick relief.  Other medication, both over the counter and prescription, that reduce stomach acid are called H-2 recpetors blockers.  Proton Pump inhibitors block acid production and help the esophagus to heal. In the case of patients with GERD this is often prescribed.

6. Surgery Is An Option

In severe cases surgery may be the only option.  Sometimes it can be performed by a less invasive type of surgery called laparoscopic surgery.  It is faster and has a quicker recovery rate than traditional surgery.  The surgery involves strengthening the weak esophageal muscles and putting the stomach back in place and making the hiatus smaller.  Often acid reflux surgery  is the less invasive type.

The benefits of laparoscopic surgery are less pain and quicker healing time. It has shorter hospital stays and a quicker return to work. This type of surgery is not for everyone. The doctors use small incisions to enter the abdomen and carbon monoxide to inflate the stomach to see well.  The operation is performed with small instruments and the device has a small video camera.  This surgery is not for everyone, for some patients traditional surgery is the only option.

The good news is that surgery is very rarely needed for this condition. A hiatal hernia can cause symptoms that interfere with everyday activities. With simple lifestyle changes or medication you can control the symptoms and enjoy life again. 

Written by: Joan Russell

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