Treatment is called for only when the hernia results in symptoms, such as persistent heartburn or difficulty in swallowing. Acid inflammation and ulceration of the lower esophagus also require treatment.
General guidelines for treating heartburn and esophagitis (inflammation of the esophagus) are:
- Relax. Sit down when you eat and chew completely. Play soothing music. Deep breathing, meditation, tai chi, yoga, or massage may also help prevent and relieve heartburn.
- Remain upright after eating. Don' bend over or lift heavy objects.
- Try a low carbohydrate diet which may lessen your acid reflux disease/GERD symptoms.
- Loosen up. Avoid tight belts, waistbands, and other clothing that puts pressure on your stomach.
- Stop smoking. Nicotine stimulates stomach acid.
- Chew gum. It can increase saliva production and soothe the esophagus.
- Consult with your doctor and/or pharmacist. Some drugs increase your susceptibility to acid reflux; aspirin and other non-steroidal anti-inflammatory drugs, estrogen, narcotics, some depression medications and some asthma medications can make your condition worse.
- Don't be misled by wedges or adjustable beds that bend at the waist. They can actually make the situation worse by forcing stomach acid up into the esophagus.
To understand the hiatal hernia (also known as a hiatus hernia), it is important to understand the anatomy. The diaphragm is a sheet of dome-shaped muscle, separating the lungs from the abdomen that contracts and flattens, pulling air into the lungs. The left diaphragm contains a small opening that allows the esophagus to pass through, carrying food and liquid to the stomach. Normally this opening or hole, called a hiatus, is small and fits tightly around the esophagus. The stomach sits below the diaphragm.
In some people, for reasons unknown, the hiatus or hole in the diaphragm weakens and enlarges. A portion of the stomach moves up into the chest cavity through this enlarged opening, creating a hiatal hernia. It is estimated that by the age of 60, up to 60 percent of people have a hiatal hernia.
In most patients, hiatal hernias cause no symptoms. When symptoms occur, they may only be heartburn, a condition when stomach acid refluxes back into the esophagus. Some patients with hiatal hernias experience chronic reflux of acid into the esophagus, which may cause injury and bleeding, resulting in anemia, or low red blood cell count. Further, chronic inflammation of the lower esophagus may produce scarring and narrowing in this area, making it difficult to swallow.
It is wrong to always blame a hiatal hernia for pain and indigestion, because generally they do not cause acute pain. This symptom may result from other disorders, of a more serious nature, such as peptic ulcers or coronary heart disease. Patients with serious pain should seek medical advice.
The complications of hiatal hernia are:
- chronic heartburn and inflammation of the lower esophagus, called reflux esophagitis
- anemia as a result of chronic bleeding from the lower esophagus
- difficulty in swallowing due to scarring and narrowing of the lower esophagus
- chronic cough, wheezing, and even pneumonia from stomach secretions seeping up the esophagus and into the lungs while sleeping
- difficulty in breathing or severe chest pain, especially in the elderly
The most common way to diagnose a hiatal hernia is through an upper GI barium x-ray. Another procedure is gastroscopy, or upper-intestinal endoscopy, in which a flexible scope allows the physician to visually examine the esophagus and stomach while the patient is lightly sedated.
A hiatus hernia is an extremely common condition which usually does not cause symptoms or problems. However, when it does, the physician can frequently treat the problem effectively with a well-planned program. Surgery is infrequently required to treat a hiatal hernia.
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