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Hiatal Hernias

Evan was totally psyched about his date - he had snagged the car for the night and had even bummed enough cash off his older brother to cover a meal at the best Mexican place in town. He wasn't even nervous, considering it was his first date with a girl he really liked. That is, until Evan was midway through his extra-spicy entrée and realized it wasn't anxiety bubbling up in his throat - it was a major case of heartburn.

Guess what - heartburn isn't something that just affects middle-aged men in antacid commercials. It can affect teens, too, and it may be caused by a condition called hiatal hernia. Before you reach for the antacids, read up on how a hiatal hernia could affect you.

What Are Hiatal Hernias?
A hernia (pronounced: her-nee-ah), or rupture, is an opening or weakness in the wall of a muscle, tissue, or membrane that normally holds an organ in place. If the opening or weakness is large enough, a portion of the organ may be able to poke through the hole. A hiatal (pronounced: high-ate-ull) hernia occurs at the opening of your diaphragm where your esophagus (the pipe that food travels down) joins your stomach. If the muscle around this opening becomes weak, the uppermost part of your stomach can bulge through the diaphragm into the chest area.

There are two types of hiatal hernias. A sliding hiatal hernia, which happens most often to people who smoke, are overweight, or are older than 50, happens when a part of the stomach and the gastroesophageal junction (where the stomach joins the esophagus) slip in and out of an opening at the diaphragm.

A paraesophageal (pronounced: par-uh-ih-sah-fah-jee-ul) hernia is the other type of hiatal hernia; it's much less common than a sliding hiatal hernia, but it can be much more serious. This type of hernia occurs when just a part of the stomach slips through the opening in the diaphragm. If the piece of stomach that has slipped into the opening in the diaphragm becomes trapped so that it can't slide back into the abdomen, it's called incarceration. This is a medical emergency because the blood supply to the tissue can be cut off and the tissue could begin to die. This tissue death is also called strangulation and can lead to infection. 

Some doctors believe that there is a link between gastroesophageal reflux disease (GERD) and hiatal hernia. People who have GERD experience acid reflux, when their stomach contents wash back up into the esophagus and even up to the throat because the muscle that connects the esophagus with the stomach, known as the lower esophageal sphincter or LES, is weakened. Hiatal hernia may weaken the LES, causing GERD.

Heartburn and the other symptoms of GERD are fairly common - more than 60 million Americans experience them once a month or more.

What Are the Signs and Symptoms?
In some cases, a person with a sliding hiatal hernia might experience no symptoms at all. Doctors call these people asymptomatic. Other people with sliding hiatal hernias experience symptoms such as:

  • heartburn, especially when you lean forward or lie down
  • frequent upset stomach
  • belching
  • regurgitation (this occurs when stomach contents flow back into the throat)

A paraesophageal hernia causes different, often more severe and painful, symptoms. In these cases, especially if the hernia becomes incarcerated, a person might feel:

  • sudden or severe chest pain
  • difficulty when swallowing

Do those symptoms sound familiar? Talk to a doctor right away because a paraesophageal hernia may require immediate medical treatment.

What Do Doctors Do?
Your doctor will ask you specific questions about your symptoms, such as when and how frequently they occur. If a diagnosis of hiatal hernia can't be made based on your symptoms and risk factors (such as being overweight or a smoker), your doctor may decide to do lab tests to confirm the diagnosis.

One common type of test used to diagnose a hiatal hernia is called an esophagoscopy (pronounced: ih-soff-ih-guh-ska-pee). During an esophagoscopy, a gastroenterologist, a doctor who specializes in stomach and intestinal problems, will use a long flexible tube attached to a video camera to see into your esophagus and evaluate whether you have a hernia. Another test is called a barium swallow, which is a special X-ray examination of the upper gastrointestinal tract. Manometry is a test that measures pressure in the esophagus and might be used to check for hiatal hernia.

In many cases, the best treatment for a hiatal hernia is to make changes in your lifestyle and diet. Often, medications used to treat gastroesophageal reflux are also added. However, especially for paraesophageal hernias, surgery might be required if the hernia is in danger of becoming strangulated, if your gastroesophageal reflux is severe, or if your esophagus becomes inflamed.

In the rare cases where surgery is needed for a sliding hiatal hernia, the doctor makes an incision over the hernia, tightens the weakened muscle, and wraps the top of the stomach around itself like a scarf to help minimize acid reflux. If the muscle has become strangulated, that part of the muscle is removed so it doesn't become infected. People who have surgery for hiatal hernia typically stay in the hospital for 4 or 5 days.

Can Hiatal Hernias Be Prevented?
Although it's difficult to prevent hiatal hernias, certain lifestyle changes may lower your risk and prevent an existing hiatal hernia from worsening.

Staying at a healthy weight for your height and body type is an important part of your overall health because excess weight places greater stress on the muscles of your abdomen. Talk to your doctor or a dietitian about a healthy eating and exercise program if you think you are overweight or obese.

The way you work out can contribute to a hiatal hernia - be careful when weight lifting or lifting heavy objects. Make sure you lift weights safely by using an appropriate amount of weight. If you have to lift something that's heavy, bend from your knees, not your waist, or don't lift it at all.

You knew smoking could harm your lungs, but did you know it places you at a greater risk for hiatal hernia? Smoking can cause persistent coughing, which can strain your abdominal muscles, so it's just one more reason to quit.

The next time you're out with your friends at your favorite restaurant, think before you order. Certain foods, such as spicy foods, acidic foods, fatty foods, chocolate, coffee, and tea can contribute to heartburn and may aggravate the symptoms of hiatal hernia. And try to keep your portions reasonable - overeating can aggravate heartburn and reflux, too.