Hernia

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What Are Hiatal Hernias?

A hiatal hernia is a weakness or stretching of the digestive tract where it passes through the diaphragm. The diaphragm is the muscle separating the chest from the abdomen (belly). Because of this stretching, acid from the stomach may flow back into the esophagus (the tube that connects the mouth and stomach). This acid causes irritation. 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 Hiatal Hernias?

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

What Are the Symptoms of Hiatal Hernias?

People often have no symptoms, but when they do occur, they are usually about an hour after meals. They include heartburn, chest pain, belching, and rarely swallowing problems. Bending over or lying down can make heartburn worse. A complication is bleeding, caused by irritation of the esophagus.

How Are Hiatal Hernias Diagnosed?

The health care provider uses endoscopy or barium swallow x-rays to diagnose hiatal hernias. In endoscopy, a small lighted tube with a tiny camera on the end is passed into the esophagus to see the hernia. Pressure measurements (manometry) may be done to prove that there is lower pressure where the esophagus and stomach meet.

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How Are Hiatal Hernias Treated?

The goals of treatment are to control symptoms and prevent complications. The main approach is changing lifestyle and diet. If you have heartburn during the night, raising the head of the bed 4 to 6 inches (with wooden blocks or bricks, not 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 ranitidine, famotidine, and proton pump inhibitors such as omeprazole.

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

DOs and DON’Ts in Managing Hiatal Hernias:
  • DO lose weight if you’re overweight.
  • DO eat slowly. Eat four or five small daily meals instead of one or two large meals.
  • DO call your health care provider if you feel that food stops beneath the breastbone.
  • DO call your health care provider if you have pain with shortness of breath, sweating, or nausea.
  • DO call your health care provider if you vomit blood or vomit often.
  • DO call your health care provider if symptoms don’t improve after 1 month of treatment.
  • DON’T drink alcohol and caffeine products (coffee, tea, cocoa, cola).
  • DON’T eat fried, spicy, and fatty foods; citrus juices; peppermint; and spices that may irritate the hernia.
  • DON’T eat large meals.
  • DON’T eat anything for at least 2 hours before bedtime.
  • DON’T bend over or lie down right after eating.
  • DON’T smoke.
  • DON’T wear tight-fitting pants, belts, and undergarments.
FOR MORE INFORMATION

Contact the following sources:

  • American College of Gastroenterology
    Tel: (703) 820-7400
    Website: http://www.acg.gi.org

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor

images
What Are Hiatal Hernias?

A hiatal hernia is a weakness or stretching of the digestive tract where it passes through the diaphragm. The diaphragm is the muscle separating the chest from the abdomen (belly). Because of this stretching, acid from the stomach may flow back into the esophagus (the tube that connects the mouth and stomach). This acid causes irritation. 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 Hiatal Hernias?

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

What Are the Symptoms of Hiatal Hernias?

People often have no symptoms, but when they do occur, they are usually about an hour after meals. They include heartburn, chest pain, belching, and rarely swallowing problems. Bending over or lying down can make heartburn worse. A complication is bleeding, caused by irritation of the esophagus.

How Are Hiatal Hernias Diagnosed?

The health care provider uses endoscopy or barium swallow x-rays to diagnose hiatal hernias. In endoscopy, a small lighted tube with a tiny camera on the end is passed into the esophagus to see the hernia. Pressure measurements (manometry) may be done to prove that there is lower pressure where the esophagus and stomach meet.

images
How Are Hiatal Hernias Treated?

The goals of treatment are to control symptoms and prevent complications. The main approach is changing lifestyle and diet. If you have heartburn during the night, raising the head of the bed 4 to 6 inches (with wooden blocks or bricks, not 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 ranitidine, famotidine, and proton pump inhibitors such as omeprazole.

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

DOs and DON’Ts in Managing Hiatal Hernias:
  • DO lose weight if you’re overweight.
  • DO eat slowly. Eat four or five small daily meals instead of one or two large meals.
  • DO call your health care provider if you feel that food stops beneath the breastbone.
  • DO call your health care provider if you have pain with shortness of breath, sweating, or nausea.
  • DO call your health care provider if you vomit blood or vomit often.
  • DO call your health care provider if symptoms don’t improve after 1 month of treatment.
  • DON’T drink alcohol and caffeine products (coffee, tea, cocoa, cola).
  • DON’T eat fried, spicy, and fatty foods; citrus juices; peppermint; and spices that may irritate the hernia.
  • DON’T eat large meals.
  • DON’T eat anything for at least 2 hours before bedtime.
  • DON’T bend over or lie down right after eating.
  • DON’T smoke.
  • DON’T wear tight-fitting pants, belts, and undergarments.
FOR MORE INFORMATION

Contact the following sources:

  • American College of Gastroenterology
    Tel: (703) 820-7400
    Website: http://www.acg.gi.org

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor