HIATAL HERNIA

General Information

DEFINITION--A weakness or stretching of the hiatus (an opening for the esophagus) located in the diaphragm (the broad, thin muscle separating the chest cavity and abdominal cavity). When this opening becomes weakened, gastric (stomach) acid flows backward from the stomach into the esophagus, irritating the esophagus. The stomach may even protrude into the lower chest.

BODY PARTS INVOLVED--Esophagus; stomach; diaphragm.

SEX OR AGE MOST AFFECTED--All ages, but most common in adults over 50.

SIGNS & SYMPTOMS--

The following symptoms usually develop within 1 hour or more after eating:

• Heartburn (a burning sensation in the area of the heart and behind the breastbone). May be confused with heart attack symptoms.
• Belching.
• Swallowing difficulty (rare).

CAUSES--Underlying cause is unknown.

RISK INCREASES WITH

• Congenital weakness in the muscular ring of the diaphragm through which the esophagus passes and empties into the stomach.
• Abdominal injury, causing tremendous pressure that tears a hole in some part of the diaphragm.
• Chronic constipation and straining during bowel movements.
• Obesity; pregnancy; smoking.
• Constant straining or lifting with tightening of the abdominal muscles.
• Age over 50.

HOW TO PREVENT--No specific preventive measures.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• For diagnosis, an esogastroscopy (passage of a viewing tube down the throat into the esophagus) may be performed. If cancer is suspected, a small amount of tissue may be removed for a biopsy. Manometry (pressure measurement) may be performed to confirm the reduced pressure at the esophagogastric junction.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Surgery to close the weakness in the diaphragm and keep the stomach in its natural place (rare). (See Hernia, Repair, Hiatal in Surgery section.)

POSSIBLE COMPLICATIONS

• Bleeding from the esophagus. This can be excessive, leading to shock.
• Misdiagnosis as a heart attack.

PROBABLE OUTCOME--Symptoms can usually be controlled. If symptoms cannot be controlled and it appears that irritation of the esophagus is causing scarring and ulceration, the condition can be corrected with surgery.

How To Treat

GENERAL MEASURES--

• The primary goals of treatment are to relieve symptoms and to manage and prevent complications. Medical therapy is used first.
• Raise the head of your bed 4 to 6 inches. This allows gravity to keep stomach acid away from the hernia.
• Don't smoke.
• Don't wear tight pantyhose, girdles, belts or pants.
• Don't strain during bowel movements, urination or lifting.

MEDICATION--Your doctor may prescribe:

• Antacids. These are most effective for some persons when they take them 1 hour before meals and at bedtime. Others find them more helpful 1 to 2 hours after meals and at bedtime. Try both ways to find the best schedule for you.
• Stool softeners.
• Drugs which hasten gastric emptying.

ACTIVITY--Don't bend over or lie down immediately after a meal.

DIET--

• Avoid large meals. Eat 4 or 5 small meals a day instead. Don't eat anything for at least 2 hours before bedtime.
• Lose weight, if you are overweight. Frequently symptoms may disappear below a specific weight. (See Weight-Loss Diet in Appendix.)
• Avoid alcoholic beverages, caffeine-containing beverages (coffee, tea, cocoa, cola drinks) and any other food, juice or spice that aggravates symptoms. Eat slowly.

Call Your Doctor If

• You have symptoms of a hiatal hernia, especially the sensation that food stops beneath the breastbone. Call immediately if pain is accompanied by shortness of breath, sweating or nausea.
• You vomit blood or have recurrent vomiting.
• Temperature rises over 100F (37.8C).
• Symptoms don't improve with treatment in 1 month.