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Hiatal Hernia
Overview

Having a hiatal hernia can be a painful condition. They occur deep inside the body and cannot be seen from the outside like other hernias. Women are affected with hiatal hernia more than men and often as a result of pregnancy. Even though they can be painful, 50% of people affected with this condition have no symptoms at all. In general, hiatal hernias are more common in people over the age of 50. This article will explain the details of hiatal hernia, how they are diagnosed, treated, and some helpful lifestyle changes to help manage the symptoms.

What is A Hiatal Hernia?

A hiatal hernia happens when the upper stomach pushes up into your chest area through an esophageal hiatus. This is an opening in the diaphragm that is normally just for the esophagus to pass through. This area of the diaphragm can become weak and stretch to allow the stomach to pass through.

Hiatal hernia is pretty common and occurs in around 60% of all adults by 60 years of age. There are two different types:

Sliding Hiatal Hernia. This happens when the stomach slides up when there is more pressure inside the abdomen. It slides back down when the pressure is relieved.
Fixed Hiatal Hernia. The hernia does not move and the upper part of the stomach is “fixed” in its position through the esophageal hiatus.

Hiatal Hernia Causes & Risk Factors

Hiatal Hernia Causes & Risk Factors

Causes

Being overweight
Congenital defect
Poor posture
Smoking
Family history
Heavy lifting
Coughing
Straining to have a bowel movement

Risk Factors

Genetics
Age over 50
Obesity

Hiatal Hernia Symptoms

If you have a very small hiatal hernia, you may not have any symptoms at all. If they are big enough to cause symptoms, you may feel:

Frequent heartburn
Chest pain
Upper abdominal pain
Trouble swallowing
Excessive belching
Extreme fullness after eating
Blood in vomit or stools

Any of the above symptoms should be evaluated by a doctor, especially if you are vomiting blood which could be a sign of a bleeding ulcer or something more serious.

Hiatal Hernia Diagnosis

If you have symptoms of a hiatal hernia, make an appointment with your doctor. Make sure you make a list of your symptoms and how long you have had them. Let your doctor know any medications you are taking and any medical history. After a physical examination, the doctor may order one or more of the following tests:

Lab Tests. You may need a Complete Blood Count – CBC, to make sure you aren’t anemic and a test for the bacteria that causes ulcers, H. Pylori. The doctor may also check your liver functions, which can cause upper abdominal pain.

Barium Swallow Study. For this test, you will need to drink a barium liquid that will allow the doctor’s to see your stomach on an x-ray. They can see any problems going on with your upper intestines, stomach, and esophagus.

Endoscopy Exam. This exam uses a lighted tube and camera to look at the stomach and esophagus. The doctor will check for signs of inflammation, ulcers, and signs of bleeding.

Manometry Exam. The doctor will place a small tube down the back of your throat to check for pressures in the esophagus.

Grading According to Type

During diagnosis, your doctor will “grade” the hernia to help determine the best treatment for you. Here are the different types and grades:

I. This is known as a “sliding hernia” and moves up and down with pressure changes in the abdomen. This is one of the more common hiatal hernias.

II. This type is a “rolling hernia” or also known as, Para esophageal. Most of the stomach remains below the diaphragm and a small portion herniates upward. This type isn’t as common.

III. This is the combined or mixed hernia. The majority of the stomach pushes up through the opening and can sometimes even twist. These are less common than type I and II.

IV. In this type, not only the stomach herniates upward but other organs like; intestines, pancreas, and spleen. This is a rare form of hiatal hernia.

Most hiatal hernias are either Type I or Type II and can be easily managed. Type III and IV often require surgery to reduce the hernia and repair the opening.

Hiatal Hernia Treatment

Once the doctor has given your hernia a type and grade, a treatment plan will be put in place. This may include one or more of the following:

Type I and Type II Showing No Symptoms.

Medications. Acid reducers, motility drugs.
Dietary Changes. Smaller more frequent meals.
Staying upright after eating.
Weight Loss.
Smoking Cessation.
Elevating the head of the bed.

Type I and Type II With Symptoms

Fundoplication Surgery. This isn’t actually a hernia repair, but takes a small amount of the upper stomach and wrapping it around the lower esophagus to prevent reflux of stomach acid and contents. This effectively treats any accompanying GERD with the hernia to improve comfort.

Type III and Type IV

Laparoscopic Surgery. This has been found to be the safest type of surgery to repair a hiatal hernia. This doesn’t require large open incisions, only small ones to place the scope in and do needed repairs. This type is effective for even severe hernias.

Home Remedies for Hernia

Alternative medicine may be helpful for symptoms of hiatal hernia. Always ask your doctor before using herbal remedies because there may be drug interactions. The following herbs may help relieve reflux and pain:

Apple Cider Vinegar. Many people find it amazing that something acidic can actually increase the acid levels in the stomach. This is because the acetic acid in apple cider vinegar has a lower pH level which lowers the stronger hydrochloric acid in the stomach. Take 2 or 3 teaspoons in 8 ounces of water with meals.

Probiotics. Increasing the “good” bacteria in the digestive system can help digest food quicker and more efficiently. They can also help balance the pH levels in the digestive tract.

Slippery Elm. This herb can leave a protective coating on the lining of the esophagus and stomach. This can lower inflammation levels. It can also increase the production of mucus in the stomach that reduces the acid levels.

Chamomile. Chamomile is a natural anti-inflammatory and can soothe stomach issues. Try drinking chamomile tea up to four times daily.

Gentian Tea. Drank ½ hour before eating, Gentian tea can ward off heartburn caused by eating. Use 1 teaspoon in one cup of water and simmer for around 30 minutes.

Calendula Tea. Can help reduce inflammation in the esophagus.

Lifestyle Changes for Hiatal Hernia

Lifestyle changes can help reduce discomfort and symptoms. Try the following:

Quit smoking and avoid second hand smoke
Eat smaller more frequent meals
Avoid greasy and spicy foods
Avoid caffeine and alcohol
Try to lose weight if overweight
Use a pillow to elevate the head of your bed when sleeping
Do not lie down after meals, sit upright for at least 30 minutes to an hour
Ask your doctor about exercises that help improve stomach muscle tone

Complications and Prognosis for Hiatal Hernia

If a hiatal hernia is severe and left untreated, the complications can include; bleeding that leads to anemia, strangulation of the stomach or intestines, aspiration of fluids into the lungs.

Type I and Type II hernia’s have a very good prognosis and are usually very manageable. Type III and IV that are severe and obstructive can have a poor prognosis if not surgically corrected.

Bibliography

Florida Hospital. (2015, August 28). Statistics of Paraesophageal Hernia. Retrieved from Florida Hospital: https://www.floridahospital.com/paraesophageal-hernia/statistics

May, L. (2011, July 23). Use natural remedies for a hiatal hernia. Retrieved from Natural News: https://www.naturalnews.com/033090_hiatal_hernia_natural_remedies.html#

Mayo Clinic. (2015, February 3). Hiatal Hernia Symptoms. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/basics/symptoms/con-20030640

P John Simic, M. F. (2014, October 23). Hiatal Hernia. Retrieved from eMedicine Health: https://www.emedicinehealth.com/hiatal_hernia/article_em.htm

Society of American Gastrointestinal and Endoscopic Surgeons. (2013, April). Guidelines for the Management of Hiatal Hernia. Retrieved from SAGES: https://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia/

University of Maryland Medical Center. (2013, July 18). Hiatal Hernia. Retrieved from University of Maryland: https://umm.edu/health/medical/ency/articles/hiatal-hernia

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