DESCRIPTIONA hiatal hernia is an abnormal weakness or opening in the diaphragm, which is the big, thin muscle that separates the chest cavity from the abdominal cavity. The esophagus, stomach, and diaphragm are involved.
Appropriate health care includes:
Self-care after diagnosis.
Physician's monitoring of general condition and medications.
Surgery to close the weakness in the diaphragm and keep the stomach in its natural place (rare).
SIGNS & SYMPTOMS"Heartburn" (a burning sensation in the area of the heart and behind the breastbone).
Swallowing difficulty (rare).
The following symptoms usually develop within 1 hour or more after eating:
CAUSESCongenital 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.
Either of the above can allow gastric (stomach) acid to flow backward from the stomach into the esophagus, irritating the esophagus. The hernia weakens the sphincter that controls the opening between the two--the stomach may even protrude into the lower chest. Lying flat or exerting abdominal pressure (like straining) may push the stomach upward.
Chronic constipation and straining during bowel movements; obesity; pregnancy; constant straining or lifting with tightening of the abdominal muscles; smoking.
PREVENTING COMPLICATIONS OR RECURRENCENo specific preventive measures.
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the esophagus and stomach.
Gastroscopy with a flexible gastroscope (See Glossary) to view the esophagus and stomach.
Bleeding from the esophagus. This can be excessive, leading to shock.
Misdiagnosis as a heart attack.
Your child's symptoms can usually be controlled with the suggestions listed below. 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.
HOME CAREInstructions for your child:
Raise the head of your bed 4 to 6 inches. This allows gravity to keep stomach acid away from the hernia.
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. A reducing diet appears in Appendix 31.
Don't wear tight pantyhose, girdles, belts, or pants.
Don't strain during bowel movements, urination, or lifting.
MEDICATIONAntacids. These are most effective for some children 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. Your child can try both ways to find the best schedule.
Your doctor may prescribe:
DIET & FLUIDS
Your child should avoid alcoholic beverages, caffeine-containing beverages (coffee, tea, cocoa, cola drinks), and any other food, juice, or spice that aggravates symptoms. Urge the child to eat slowly and chew food thoroughly (35 to 50 chews for each mouthful).
OK TO GO TO SCHOOL?When appetite has returned and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your child has 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.
Your child vomits blood or has recurrent vomiting.
Temperature rises over 100F (37.8C).
Symptoms don't improve with treatment in 1 month.