Hiatal Hernia

What is a hiatal hernia?

A hernia is a protrusion of part of an organ through the muscle wall that surrounds it. A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the stomach from the chest. A hiatal hernia results in retention of acid and other contents above this opening. These acids and other substances can easily back up (reflux) into the esophagus.

There are two types of hiatal hernias - a sliding hiatal hernia and a paraesophageal hernia. Most of the time, a hiatal hernia does not produce symptoms, but heartburn, belching, and sometimes regurgitation (backflow of stomach content into the esophagus/throat) can be present with a sliding hiatal hernia.  Severe symptoms are usually associated with a paraesophageal hernia.

A physician will perform a medical exam and medical history. A chest X-ray, upper endoscopy, barium swallow, or manometry may be ordered to confirm the diagnosis.

Many people age 50 and over have small hiatal hernias; however, hiatal hernias may affect people of all ages.

What causes hiatal hernia?

Suggested causes of hiatal hernia include the following:

  • coughing
  • vomiting
  • straining while defecating (having a bowel movement)
  • sudden physical exertion
  • pregnancy

Obesity and pregnancy can also contribute to this disorder.

Treatment for hiatal hernia:

Specific treatment for hiatal hernia will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the condition
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Although hiatal hernias usually do not require treatment, treatment may be necessary if the hernia is:

  • in danger of becoming strangulated (twisted in a way that cuts off blood supply).
  • complicated by severe gastroesophageal reflux disease (GERD).
  • complicated by esophagitis (inflammation of the esophagus).

Medication may be prescribed by a physician to neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter. The esophageal sphincter is the muscle that prevents stomach acid from coming up into the esophagus. Surgery may also be needed in these cases to reduce the size of the hernia, or to prevent strangulation.

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