Hiatal Hernia

Normally the stomach resides in the abdominal cavity. In hernia, the stomach protrudes through an opening (hiatus) in the diaphragm into the chest cavity, and hence the term hiatal hernia. A part of the stomach

A part of the stomach resides in the abdomen, whereas the rest of it is in the chest. Hiatal hernia is not static, and it may come in and out of chest.

The incidence was believed to be only two percent in the 1920s. However, with improvements in technology leading to increased recognition, the number rose to 15% by 1955. More recently, studies quote the incidence to be as high as fifty to eighty percent of the adult population.

People of all ages can get this condition; however it is more common with aging. It is rare among young adults, but very common above the age of sixty. The size of hernia increases over time.

The most common is the sliding type. Quite simply, a part of the stomach just slides up into the chest cavity. The other major type, although very uncommon, is the Para esophageal type. In the latter, the junction of the esophagus and stomach stays put at the level of diaphragm whereas a part of the stomach protrudes up into the chest. Such a situation must be corrected surgically, since it can lead to a life threatening strangulation of the hernia.

Frequently, the hiatal hernia is associated with acid reflux or heartburn. You can have a hernia without acid reflux and vice versa; frequently the two conditions go together, and we don't know exactly which is the cause and which is the effect.

Some people believe that neither the hernia nor the acid reflux is the cause, but they co-occur because of failure of some different mechanism. When they co-exist, they tend to worsen each other.

For example, the lower esophageal sphincter is supposed to prevent the reflux of stomach contents into the esophagus. When hernia occurs, the sphincter loses the support of the diaphragmatic muscles around it. This weakened sphincter is less efficient in preventing acid reflux from stomach into the esophagus.

The hiatal hernia may also serve as a reservoir from which acid can easily regurgitate into the unprotected esophagus.

Various theories have been expounded, however the exact cause of hiatal hernia remains a mystery. Dietary differences have been implicated since it is very common in the west and rare in Asia and Africa.

pulling the stomach into the chest. The shortening occurs because of malfunctioning of nerves in the lower part of the esophagus.

Just because you have a hiatal hernia does not mean that you have a problem at hand. In fact, they don't cause any problem in most people. In many patients however, acid reflux may worsen.

Patients with hiatal hernia tend to have greater acid induced damage to the esophagus. The sliding of stomach in and out of abdomen may cause friction at the neck of the hernia leading to ulcers. Giant hernias may cause anemia, bleeding and chest pain. Para esophageal hernia is prone to strangulation.

The diagnosis is usually made as incidental finding during upper GI x ray or upper endoscopy.

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Treatment is only needed if the hiatal hernia is causing problems, and such is not the case in most patients.

If you have both hiatal hernia and acid reflux, make life style changes needed for heartburn, including raising the head end of bed for sleep (not pillows), cessation of smoking, avoiding large meals and foods that predispose to acid reflux, and weight reduction in case of overweight individuals.

Patients may be prescribed acid blocking medications like Zantac, Tagamet, Axid, Pepcid, Prevacid, Prilosec, Aciphex, Protonix and Nexium etc.

This is meant to be an informational exercise and NOT a medical consultation. Your doctor is the only one who can best assess your situation and offer you medical advice.