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About Hiatus Hernia

by Janey Lewis
  • Overview

    A hiatus hernia, also called a hiatal hernia, happens when a part of the stomach pushes upward into the chest region through an opening in the diaphragm. The diaphragm is a muscle that assists with breathing. Many people have a small hiatus hernia and never realize it. However, a large hiatus hernia can cause significant discomfort, including pain and heartburn.
  • Causes

    Doctors aren't sure what causes a hiatus hernia to form. Age seems to be a factor, since hiatus hernias often occur in adults over age 50. People who are overweight have a greater chance of suffering from hiatus hernia. Children with hiatus hernia are usually born with the condition. Injury can also cause the hernia, but anything that puts extra pressure on the stomach can cause it to develop. Pregnancy, intense vomiting and lifting extremely heavy things can all cause the hernia to form.
  • Symptoms

    The symptoms of hiatus hernia are similar to the symptoms of gastric reflux. A patient experiences heartburn, pain in the chest, frequent belching and sometimes nausea and vomiting. Symptoms are aggravated when the person lies flat or bends over. Hiatus hernia symptoms can be greatly exaggerated during pregnancy. Patients with a hiatus hernia can develop gastroesophageal reflux (GERD), which has many of the same symptoms.
  • Treatment

    Treatment is usually done to relieve symptoms, rather than repair the hernia. Many patients find some relief in over-the-counter antacids, such as Tums or Mylanta. Other over-the-counter medications that work include H-2 blockers, which reduce acid by blocking certain receptors. H-2 blockers included ranitidine (brand name Zantac), cimetidine (brand name Tagamet) and famotidine (brand name Pepcid). For more difficult cases, a doctor may prescribe a stronger dose of an H-2 blocker or a proton pump inhibitor, such as esomeprazole (brand name Nexium), omeprazole (brand name Prilosec) or lansoprazole (brand name Prevacid).
  • Surgery

    Most patients with hiatus hernia control their symptoms with medications, but a few require surgery if symptoms are severe. Some patients experience bleeding in the esophagus, shortness of breath or chest pain. During the surgery, the physician makes the opening in the diaphragm smaller or he may actually remove the hernia. This can be done through traditional open surgery or with laparoscopic surgery, which involves making a small incision and using a tiny camera to see inside the body. This usually allows for a shorter recovery time.
  • Lifestyle Changes

    People who are obese and have hiatus hernias usually find that losing weight makes a significant decrease in symptoms. Eating smaller meals and staying away from acidic and fatty foods can help. Patients who smoke should stop, since smoking causes an increase in stomach acid. It's also important not to eat for several hours before bedtime, since lying down causes acid to flow backward into the esophagus. Some people with severe symptoms find raising the head of their bed helps. Stress is also a factor, since it slows down digestion.

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