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Hiatal Hernia

Definition/Anatomy

The presence of part of the stomach which has herniated or been pushed up above the diaphragm The diaphragm is a sheet of muscle that separates the chest and the abdominal cavities. It was previously thought that hiatal hernias were the main problem that caused the reflux of the acid material from the stomach into the esophagus. Now studies have shown that many people over the age of 50 have hiatal hernias. Many of these people have no symptoms whatsoever. Often when a person thinks he has a "hiatel hernia," it likely not the real problem, but rather that the valve (lower esophageal sphincter) is not functioning properly.

Types

Sliding hiatal hernia

A sliding hiatal hernia is present when the stomach and the section of the esophagus that joins the stomach slide up into the chest through the diaphragm opening.

Fixed hiatal hernia

All types are classified by where that herniation is located in relation to the diaphragm. A fixed hernia.

Complicated or serious chital hernia

Complicated or serious chital hernia is a hernia in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.

Symptoms

Hiatal hernias often have no symptoms or only minimal symptoms. Symptoms may include feelings of heartburn that worsen when lying down, sour taste in mouth, vague, nonspecific abdominal complaints such as indigestion, trouble swallowing, feeling full after eating only a small amount of food, or a feeling that you have a lump in your throat

Diagnosis

Diagnosis is made with radiation exams and upper endoscopy procedures.

Complications

Hernia can become bigger and in rare cases become entrapped.

Treatment

Lifestyle changes

Certain foods and other substances make this condition worse by further interfering with the valve function. Included are alcohol, peppermint, tobacco, caffeine, and particularly, fatty foods (fried or greasy foods). These all lower the pressure of the valve making it even more incompetent

Medications

Initial treatment for this problem involves medication. Patients with mild reflux may find relief with over the counter agents Antacids, or hydrogen 2 (H2) receptor blockers. Axid, pepcid, zantac, tagamet. Prilosec OTC is the first available over the counter acid pump inhibitor. Stomach acid pump inhibitors are the strongest class of medication available to treat reflux. Most of these are available by prescription only Prevacid, Medium, Cipher, Proton, Sigrid and generic omeprazole. In general, most gastroenterologists will recommend a limited trial of these medications

Surgery

In some cases medication is not effective in treating this problem. Laparoscopic surgery (Nissen fundoplication) may be required, and certain studies before surgery are needed Esophageal manometry.

Summary

Hiatal hernia may cause patients to experience symptoms     or not. Many times medication can control these     symptoms.  If symptoms become troublesome further    testing may need to be done.

Organizations

  1. American Society for Gastrointestinal Endoscopy - www.asge.org
  2. American Gastroenterological Association - www.gastro.com
  3. American College of Gastroenterology - www.acg.gi.org

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