By: Jennifer Jope for Reflux1 Dinner was spicy, or maybe you had one too many cups of coffee today and now heartburn or an upset stomach have set in. But your body’s sensitivity may go a little deeper than just your choice of food and beverages. It may be a hiatal hernia.
This is a condition that causes the stomach to protrude upward through the chest and through the opening of the diaphragm. According to the Mayo Clinic, symptoms typically include chest pain, heartburn or belching, which occurs when stomach acid backs up into the esophagus (an effect called acid reflux). These symptoms can be exacerbated when you lean forward, strain, lift heavy objects or lie down. Pregnancy can also make the symptoms worse.
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To lessen the impact of a hiatal hernia, try these tips:
Eat small meals – large quantities of food can distend the stomach, pushing it into your chest.
Avoid problem foods like onions, spicy foods, caffeinated rinks and chocolate. Limit your intake of citrus fruits and tomato-based foods which are acidic and can irritate the esophagus.
Curb fatty food intake.
Sit up after eating and wait at least three hours before going to bed or taking a nap.
Hold off on exercising immediately after eating.
Lose weight. Excessive weight puts pressure on the stomach.
Avoid tight-fitting clothes because they also put pressure on the stomach.
Quit smoking. Smoking increases acid reflux and dries saliva. Saliva is necessary to protect the esophagus from stomach acid. |
Hiatal hernias are common and people tend to develop them during middle age. Because the hernia doesn’t always cause symptoms, many people are not even aware they have one. While the cause is not entirely known, it’s believed that the diaphragm weakens with age, which allows the stomach to protrude through the hole in the diaphragm. Some research points to regular coughing and obesity as risk factors for hiatal hernias.There are two types of hiatal hernias: sliding and rolling. The sliding hiatal hernia is considered the most common and typically the hernia will slide up and down, in and out of the lower chest. They are typically small in size. The rolling hiatal hernia is less common and occurs when part of the stomach protrudes upward through the hole in the diaphragm next to the esophagus.
In healthy people without hernias, the diaphragm and the lower esophageal sphincter are aligned. The sphincter relaxes to allow food and liquids to flow into the stomach when swallowing occurs. The diaphragm acts as a support and puts pressure on the sphincter to keep it closed when there is no swallowing. The hernia disrupts the pressure and the sphincter then opens at the wrong times, allowing stomach acid to move into the esophagus.
According to the National Library of Medicine, treatment includes medication that neutralizes stomach acidity, decreases acid production or strengthens the lower esophageal sphincter.
Several studies have been published this year relating to hiatal hernias and their effect on the esophagus. In the March issue of Alimentary, Pharmacology & Therapeutics, researchers in Italy discovered that the presence of a hiatal hernia is a strong predictor of “more prolonged proximal oesophageal acid exposure and clearance.” The study suggested these findings should help when considering the treatment for acid reflux disease.
If there are no symptoms, there is no need for treatment. However, in rare instances, the hernia may create other complications, such as cancer of the esophagus. The risk of cancer increases when acid reflux is severe and long-term. However, the risk of developing the cancer is small.
While medication and other practices may help prevent the acid reflux associated with hiatal hernias, there has been research in recent years to determine whether laparoscopic surgery would repair this ailment. In the March issue of Surgical Endoscopy, researchers noted that the recurrence rate after laparoscopic repair of hiatal hernias with paraesophageal involvement was high. To solve this problem, researchers had proposed using mesh reinforcement. This study found that the laparoscopic repair is “challenging,” however the recurrence rate is lowered if mesh is used to reinforce the surgery.
