HIATAL HERNIA

The hiatus is an opening in the diaphragm. A hernia occurs any time an internal body part pushes into an area where it doesn’t belong. A hiatus hernia forms at the opening where your esophagus joins your stomach. Part of the stomach pushes through this opening up into the chest. There are two main types of hiatal hernias:
1. Sliding hiatal hernia ---- the stomach and the section of the esophagus that joins the stomach slides up into the chest through the hiatus.
2. Para esophageal hernia ---- the stomach and the esophagus stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus.

The cause of a hiatus hernia is most time unknown. Some people develop this due to the following:
• after sustaining an injury to that area of the body
• increased pressure in the abdomen from coughing or lifting heavy objects
• straining during bowel movements
• pregnancy and delivery
• substantial weight gain
• born with an inherent weakness or unusually large hiatus opening
In addition to the increased occurrence in overweight people (especially women), hiatal hernias also occur more often in people over fifty and smokers.

Most small hiatal hernias don’t cause any problems. But if you’re experiencing recurrent gastro esophageal reflux, there are some medications and self-care measures that can usually relieve your symptoms. Larger hernias may cause the following signs and symptoms when stomach acids back up into your esophagus (GERD):
• heartburn
• chest pain
• nausea
• belching
• bleeding and anemia

These signs and symptoms tend to become worse when you lean forward, strain, lie down, lift heavy objects and during pregnancy. Nevertheless, a variety of lifestyle changes can ease or relieve these symptoms. Some or all of the following measures may help:
• sit up after you eat at least 3 hrs. so that most of the food in your stomach will have emptied into your small intestines and it can’t flow back into your esophagus
• elevate the head of your bed six to nine inches so that gravity will help prevent acid reflux
• limit fatty foods which relax the lower esophageal sphincter and slow stomach emptying
• avoid problems foods (chocolate, onions, spicy foods, citrus fruits, tomato-based foods, spearmint and peppermint, decaffeinated drinks and alcohol
• eat small meals because large meals can distend the stomach pushing it into your chest
• lose weight (most important) and avoid tight fitting clothes to help reduce the pressure on the stomach
• stop smoking which increases acid reflux and dries your saliva
• take time to relax because stress slows digestion which makes GERD symptoms worse
• avoid certain medications, if possible such as aspirin, ibuprofen, sedatives, tranquilizers, quinidine, alendronate, naproxen sodium, nonsteroidal anti-inflammatory drugs, antibiotic tetracycline, calcium channel blockers and theophylline

A hiatal hernia can be diagnosed with specializes X-ray studies (barium swallow) or CT of the abdomen and with endoscopy.

Treatments if lifestyle changes that were mentioned above aren’t effective include the following:
• medications ---- antacids, H-2 blockers, proton pump inhibitors (PPIs)
• surgical repair

http://www.medicinenet.com/hiatal http://www.mayoclinic.com/health/hiatal-hernia
http://www.webmd.com/heartburn-gerd http://www.acg.gi.org/patients/women/whatisgerd.asp?