The diaphragm is a sheet of muscle that separates the chest from the abdomen. It is located just below the rib cage. It contains an opening which is large enough for the esophagus (food pipe) to pass through. This opening is referred to as the esophageal hiatus or the hiatal opening. If the size of this opening is larger than normal, a part of the stomach can protrude from the hiatus. When a part of the stomach is pushed up into the chest cavity through the hiatus, one is diagnosed with a medical condition called hiatal or hiatus hernia. Though this condition generally develops in adults who have crossed the age of 50 years, it could even be present at birth.
Hiatus hernia is mainly classified into the sliding, rolling and mixed hiatus hernia. In the sliding type, a part of the stomach slides up and down through the hiatal opening. The rolling type is also referred to as pure paraesophageal hiatus hernia. In this type, the gastroesophageal junction stays at its place, but a part of the stomach is pushed up through the hiatal opening. As a result, the portion of the stomach that protrudes upwards lies alongside the esophagus. The portion of the stomach that bulges upwards remains stuck in the chest cavity. The sliding type is more common than the rolling type. The mixed type, as the name suggests, is a combination of the sliding and the rolling type.
As mentioned earlier, one of the main causes of this condition is the large size of the esophageal hiatus. This condition can also develop if the esophagus is very loosely attached to the diaphragm. Weakness of diaphragm, obesity, smoking, drug abuse and stress are some of the common risk factors for this condition. Increased pressure on the abdominal region could also put one at an increased risk of developing this condition. No wonder, women who have undergone multiple pregnancies could develop this condition. Frequent episodes of violent coughing or sneezing, chronic constipation, poor posture and weight-lifting could make one susceptible. It is not uncommon for people suffering from this condition to develop gastroesophageal reflux disease. This disease is known to aggravate hiatal hernia symptoms.
While sliding or rolling hiatus hernia are usually asymptomatic, affected individuals may experience certain symptoms if they also suffer from gastroesophageal reflux disease. Gastroesophageal reflux disease is a medical condition that is characterized by the backflow of stomach acid to the esophagus. The regurgitation of gastric juices towards the esophagus gives rise to inflammation, scarring and ulceration of the esophagus. Various symptoms may develop due to the shortening of the esophagus which in turn may be caused by acid reflux disease.
The patients might experience difficulty in swallowing, pain, burning sensation, nausea, vomiting, tightness in chest, lump in throat feeling, bloating, belching, heartburn or a feeling of fullness in the upper stomach after meals. Acid reflux can also cause hiccups or shortness of breath. The symptoms may be more severe in case of a large hernia. Complications are most likely to arise when the blood supply to the stomach is cut off. This can happen if the part of the stomach that protrudes becomes twisted or pinched by the diaphragm. This life-threatening condition is known as strangulated hernia.
When hernia is accompanied by acid reflux disease, the esophagus is exposed to stomach acid. This can cause scarring, inflammation and ulcers in esophagus. If you have been experiencing any of the symptoms associated with these conditions, you must seek medical help at the earliest. Doctors often follow a symptomatic approach for treating this condition. Their aim is to ease the discomfort caused by heartburn, indigestion and acid reflux. They usually prescribe medicines that reduce the production of stomach acid and neutralize stomach acidity. Proton pump inhibitors, H-2 receptor blockers and antacids are some of the drugs that are recommended for alleviating the symptoms of acid reflux. While antacids help to neutralize the stomach acidity, H-2 receptor blockers help to decrease the production of acid. Proton pump inhibitors help in healing the damaged tissue of the esophagus.
Making some lifestyle modifications might also help. It would be a good idea to have several smaller meals instead of heavy meals. You must also avoid spicy food. If the patient is a smoker, he/she should quit smoking. One must cut down on the intake of alcohol. Since obesity makes one susceptible to hernia, it would be in one's best interest to keep a tab on one's weight. One must also follow the dietary guidelines suggested by the doctor. Lifestyle-related changes and drug therapy may prove beneficial when the symptoms are mild and the hernia is not too big. If the symptoms persist, doctors might suggest surgery to restore the stomach to its normal position. Surgery is often recommended in case of a large hernia. Surgery may be performed laparoscopically. It will involve pushing down the herniated portion of the stomach and reducing the size of the hiatal opening.
Hiatus hernia can be asymptomatic or symptomatic. If you are experiencing any of the aforementioned symptoms, it would be best to consult a doctor for a proper diagnosis. Barium X-rays, esophagoscopy and esophageal manometry are some of the diagnostic procedures that may be conducted for diagnosing this condition. If these test results are indicative of this condition, follow the advice of the doctor and do make the aforementioned lifestyle-related changes.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.