Hiatal Hernia: Causes, Symptoms and Treatment

The diaphragm, is a thin flat dome shaped sheet of muscle that lies below the chest and above the abdomen, separating the two. It is the main muscle used in respiration. In the human body, the esophagus passes down into the chest, and then reaches the stomach by passing through a hole in the diaphragm called the esophageal hiatus. The esophagus joins the stomach just below the diaphragm. The esophageal hiatus opening, is larger than normal in people with hiatal hernia, which allows a portion of the upper stomach to slip (herniate) through the hiatus and into the chest.

While the exact cause of hiatal hernia is unclear, there are a few possible causes. One strong possibility is that in some people the esophagus gets permanently shortened and consequently pulls the stomach up. This shortening may take place because of inflammation and scarring from the reflux, or regurgitation of stomach acid. The other possible cause is an abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.

Hiatal hernias, if present in children, are usually a congenital defect (they are born with it). However, hiatal hernias that occur in adults have usually developed over a period of time. This condition is very common in people over the age of 50. This condition may aggravate a preexisting condition, where gastric acid from the stomach travel back into the esophagus (gastroesophageal reflux), or cause it. Certain factors, such as increasing age, obesity, and smoking are known to heighten the risk of developing this condition.

Usually, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patient experiences is due to the reflux of gastric acid, air or bile. While there are several causes of reflux, it does happen more frequently in the presence of hiatal hernia. Thus, the symptoms of belching, chest pain, heartburn, which worsens when bending over or lying down, and difficulty while swallowing, are caused by acid reflux, but could indicate an underlying hiatal hernia condition.

After listening to a patients symptoms and conducting an exam, a doctor might ask a patient to undergo a Barium swallow x-ray or a Esophagogastroduodenoscopy (EGD) to clearly diagnose hiatal hernia.

Most of the time, treatment for hiatal hernia is to relieve the patient of the symptoms and to prevent further complications. The discomfort caused by gastroesophageal reflux, can be eased by medications that neutralize stomach acidity, decrease acid production, or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esphagus). However, if these steps do not control the symptoms or complications which appear, surgical repair of the hernia may be necessary. Surgery involves pulling down of the stomach, back into the abdomen, closing the esophageal hiatus to its correct size, and attaching the esophagus firmly to the diaphragm.

There are several steps a patient can take to achieve relief from the symptoms of hiatal hernia caused by gastroesophageal reflux. The first would be to follow a GERD diet, and supplement it with lifestyle changes. They include maintaining an upright posture during and after meals and sleeping on ones left side, preferably with the head elevated. The last food intake should be approximately 2 hours before bed time. Steps like loosing extra weight and cease smoking, will not only impact a persons overall health, but also alleviate symptoms.