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What is hiatal Hernia?
A hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region. The diaphragm is a large muscle that lies between your abdomen and chest. We use this muscle to help us breathe. Normally, your stomach is below the diaphragm, but in people with a hiatal hernia, a portion of the stomach pushes up through the muscle. The opening it moves through is called a hiatus. This condition mostly occurs in people who are over 50 years old. It affects up to 60 percent of people by the time they’re 60 years old, according to the Esophageal Cancer Awareness Association.
In some people, injury or other damage may weaken muscle tissue. This makes it possible for your stomach to push through your diaphragm. Another cause is putting too much pressure (repeatedly) on the muscles around your stomach. This can happen when:
straining during bowel movements
lifting heavy objects
Some people are also born with an abnormally large hiatus. This makes it easier for the stomach to move through it. Factors that can increase your risk of a hiatal hernia include:
Types of Hiatal Hernia
Two types of hiatal hernia:
Sliding hiatal hernias
Fixed, or paraesophageal, hernias.
Sliding hiatal hernia - This is the more common type of hiatal hernia. It occurs when your stomach and esophagus slide into and out of your chest through the hiatus. Sliding hernias tend to be small. They usually don’t cause any symptoms. They may not require treatment.
Fixed hiatal hernia - This type of hernia isn’t as common. It’s also known as a paraesophageal hernia.In a fixed hernia, part of your stomach pushes through your diaphragm and stays there. Most cases are not serious. However, there is a risk that blood flow to your stomach could become blocked. If that happens, it could cause serious damage and is considered a medical emergency.
Symptoms of a hiatal hernia
Common symptoms include:
heartburn that gets worse when you lean over or lie down
chest pain or epigastric pain
Bad taste in your mouth
Upset stomach and vomiting
Backflow of food or liquid from your stomach into your mouth
Shortness of breath
Your doctor may have you drink a liquid with barium in it before taking an X-ray. This X-ray provides a clear silhouette of your upper digestive tract. The image allows your doctor to see the location of your stomach. If it’s protruding through your diaphragm, you have a hiatal hernia.
Your doctor may perform an endoscopy. He or she will slide a thin tube in your throat and pass it down to your esophagus and stomach. Your doctor will then be able to see if your stomach is pushing through your diaphragm. Any strangulation or obstruction will also be visible.
If you have acid reflux and heartburn, you may be treated with medications or, if those don’t work, surgery.
Medications your doctor may prescribe include:
over the counter antacids to neutralize stomach acid
over the counter or prescription H2 receptor blockers that lower acid production
over the counter or prescription proton pump inhibitors to prevent acid production, giving your esophagus time to heal
If medications don’t work, you might need surgery on your hiatal hernia. However, surgery is not commonly recommended. Surgery is generally used for people who aren't helped by medications to relieve heartburn and acid reflux, or 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, reconstructing an esophageal sphincter or removing the hernia sac. Or your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery). Sometimes surgery is done using a single incision in your chest wall (thoracotomy).
Hernias can come back after surgery. You can reduce this risk by:
staying at a healthy weight
getting help lifting heavy objects
avoiding strain on your abdominal muscles
Acid reflux causes most hiatal hernia symptoms. Changing your diet can reduce your symptoms. It may help to eat smaller meals several times a day instead of three large meals. You should also avoid eating meals or snacks within a few hours of going to bed.
There are also certain foods that may increase your risk of heartburn. Consider avoiding:
foods made with tomatoes
Other ways to reduce your symptoms include:
raising the head of your bed by at least 6 inches
avoiding bending over or lying down after eating
Reducing your risk of hiatal hernias
You may not avoid a hiatal hernia entirely, but you can avoid making a hernia worse by:
losing excess weight
not straining during bowel movements
getting help when lifting heavy objects
avoiding tight belts and certain abdominal exercises
Hiatal hernia treatment often involves medication, surgery, or lifestyle changes. These at-home exercises may help push the stomach back down through the diaphragm to relieve symptoms: Drink a glass of warm water first thing in the morning.
Surgery may also be needed in people with a hiatal hernia who have severe, long-lasting (chronic) esophageal reflux whose symptoms are not relieved by medical treatments. The goal of this surgery is to correct gastro esophageal reflux by creating an improved valve mechanism at the bottom of the esophagus.
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