Very Common, Yet High Predisposition
The hiatal (hiatus) hernia is one of the most misunderstood and maligned conditions in medicine. Patients with a hiatal hernia need to understand what it is and what might occur with it. Most importantly, they need to know it is unusual for serious problems to develop from this type of hernia.
2. Fixed Hiatus Hernia — In this case, the upper part of the stomach is caught up in the chest. Even with this hernia, there may be few symptoms. However, the potential for problems in the esophagus is increased.
3. Complicated or Serious Hiatus Hernia — Fortunately, this type of hernia is uncommon. It includes a variety of patterns of herniation of the stomach, including cases in which the entire stomach moves up in the chest. There is a high likelihood that medical problems will occur with this hernia and that treatment, frequently involving surgery, will be required. Complicated hernias are uncommon.
Effects & Pain?
- Chronic heartburn and inflammation of the lower esophagus, called reflux esophagitis
- Anemia due to chronic bleeding from the lower esophagus
- Scarring and narrowing of the lower esophagus causing difficulty in swallowing
- While sleeping, stomach secretions can seep up the esophagus and into the lungs causing chronic cough, wheezing, and even pneumonia
In addition, the complicated hernia can cause serious problems such as difficulty in breathing or severe chest pain, especially in the elderly.
General guidelines for treating heartburn and esophagitis (inflammation of the esophagus) are:
- Avoid (or use only in moderation) foods and substances that increase reflux of acid into the esophagus, such as Alcohol, Caffeine, Nicotine (cigarettes), Chocolate, Fatty foods, Peppermint, and Spearmint.
- Eat smaller, more frequent meals and do not eat within 2-3 hours of bedtime.
- Avoid bending, stooping, abdominal exercises, tight belts, and girdles all of which increase abdominal pressure and cause reflux.
- If overweight, lose weight. Obesity also increases abdominal pressure.
- Prescription medications. Certain drugs, such as intestinal antispasmodics, calcium channel blockers, and some antidepressants weaken the muscle strength of the lower esophagus.
- Elevate the head of the bed 8 to 10 inches by putting pillows or a wedge under the upper part of the mattress. Gravity then helps keep stomach acid out of the esophagus while sleeping.
Drugs & Surgery
- Drugs — Some medicines effectively reduce the secretion of stomach acid, while others increase the muscle strength of the lower esophagus, thereby reducing acid reflux.
- Surgery — The complicated hiatus hernia requires surgery occasionally on an emergency basis. Surgery otherwise is reserved for those patients with complications that cannot be handled with medications. The mere presence of a hiatus hernia is not a reason for surgery.
A hiatus hernia is an extremely common condition which usually does not cause symptoms or problems. However, when it does, the physician can frequently treat the problem effectively with a well-planned program. Surgery is infrequently required to treat a hiatus hernia.
Author: Frank W. Jackson, M.D.