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What is a Hiatal Hernia?


A Hiatal Hernia is a weakness is a weakness or stretching of the upper digestive tract where is passes through the diaphragm. The diaphragm is the large muscle that separates your chest cavity from your abdominal cavity (belly). Because of this stretching, acid from the stomach may flow back into the esophagus (the swallowing tube that connects the mouth and stomach). This acid causes irritation and heartburn. Part of the stomach may also come up through the opening into the lower chest. Hiatal Hernias can affect people of all ages, but they are more common in people older than 50.


What Causes a Hiatal Hernia?


The cause is unknown. Obesity, pregnancy, straining or lifting with tightened abdominal muscles, coughing, abdominal trauma, and long-term constipation or straining with bowel movements may slightly increase the chance of having a hiatal hernia.


What are the Symptoms of a Hiatal Hernia?


People often have no symptoms, but when they do occur, it is usually after meals. They include heartburn, chest pain or upper abdominal pain, belching, and occasionally swallowing problems. Bending over or lying down can make heartburn worse. Complications like bleeding, ulcers, or narrowing and scarring of the food passage is caused by irritation of the esophagus from chronic heartburn and acid reflux.


How is a Hiatal Hernia Diagnosed?


Your doctor uses endoscopy or barium swallow x-rays to diagnose a hiatal hernia. In endoscopy, a small lighted tube with a tiny camera on the end is passed into the esophagus and stomach to see the hernia. Pressure measurements (manometry) are rarely done to prove that there is lower pressure where the esophagus and stomach meet or to check for a motility (movement) problem in the esophagus.


How is a Hiatal Hernia Treated?


The goals of treatment are to control symptoms and prevent complications. The main approach is changing your lifestyle and diet. Raising the head of the bed 4 to 6 inches (with wooden blocks or bricks, as oppose to pillows), will keep stomach acid from backing up and reaching the esophagus during sleep. Avoid foods and drinks that make symptoms worse.

Medicines can be used when these changes aren’t enough. Antacids neutralize stomach acid, and drugs to reduce stomach acid include H2-Blockers like Ranitidine (Zantac), and Proton-Pump Inhibitors (PPIs) such as Omeprazole (Losec).

If symptoms cannot be controlled or complications such as scarring, ulceration, or bleeding occur, surgery may be needed to correct the hernia.

Is there Minimally Invasive Surgery for a Hiatus Hernia?

Yes! Laparoscopic Nissen Fundoplication is an option for patients who are dependent on antacids, with typical symptoms, and have a low pressure valve. The procedure is relatively low risk, and can be completed with small key-hole incisions. Surgery and medical management are equivalent in regards to symptom control, However with surgery, most patients no longer need to take antacids for the rest of their lives. 

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