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Understanding Hiatal Hernias and Acid Reflux

Heartburn and regurgitation do not always signal that you have GERD (gastroesophageal reflux disease), even though that is a common condition linked to these symptoms. A large hiatal hernia can allow food and acid to back up into your esophagus, also leading to these symptoms.

What Is a Hiatal Hernia?

A hiatus is a small opening in your diaphragm through which your esophagus passes before connecting to your stomach. The vast majority of hiatal hernias are called type I or sliding hiatal hernias. In this type, the stomach intermittently slides up into the chest through the small opening in the diaphragm. Type II, III and IV hiatal hernias are called paraesophageal hernias. They occur when a portion of the stomach pushes up into the chest adjacent to the esophagus.

A small hiatal hernia usually doesn't cause problems. You may never know you have it unless your doctor finds it when checking for another condition. Larger hiatal hernias usually make themselves known with uncomfortable symptoms.

Symptoms of Hiatal Hernias

Large hiatal hernias can cause these symptoms:

  • Heartburn
  • Regurgitation of food or liquids
  • Backflow of stomach acid into the esophagus (acid reflux)
  • Difficulty swallowing
  • Chest or abdominal pain
  • Feeling full soon after you eat
  • Shortness of breath
  • Vomiting of blood or passing of black stools

Causes of Hiatal Hernias

It's not always clear what causes hiatal hernias, but some possible origins include:

  • Age-related changes in your diaphragm
  • Injury to the area
  • Being born with an unusually large hiatus
  • Pregnancy
  • Obesity
  • Persistent and intense pressure on the surrounding muscles, such as while coughing, vomiting, straining during a bowel movement, exercising or lifting heavy objects

A hiatal hernia can develop in people of all ages and sexes, although it frequently occurs in people 50 years and older. A hiatal hernia also occurs more often in people who are overweight and smokers.

Diagnosis of Hiatal Hernias

The diagnosis of a hiatal hernia can be challenging because of the shift in the anatomy of the esophagogastric junction during breathing and movement. It is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. These tests or procedures include a barium X-ray or CT scan of your upper digestive system, an upper endoscopy, or an esophageal manometry.

Treatment of Hiatal Hernias

Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.

For many people, these lifestyle and medication changes will control the symptoms:

  • Eating meals at least three to four hours before lying down
  • Eating moderate to small portions of foods
  • Limiting fatty foods, acidic foods, foods containing caffeine and alcoholic beverages
  • Losing weight or maintaining a healthy weight
  • Antacids or acid suppression medicines
  • Sleeping in a slightly elevated position
  • Quitting smoking

Sometimes a hiatal hernia requires surgery. Surgery is generally used if you aren't helped by medications and lifestyle changes or if you have complications, such as severe inflammation or narrowing of the esophagus.

Surgery to repair a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller or reconstructing an esophageal sphincter. One study that followed 100 patients who underwent anti-reflux surgery found a 90 percent reduction in symptoms after 10 years.

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