Hernia in the diaphragm (hiatal) and associated acid indigestion: Identifying symptoms and available treatments
A hiatal hernia is a common condition where the stomach bulges through a gap in the diaphragm, leading to acid reflux and other symptoms. This article provides an overview of the symptoms, diagnosis, and treatment options for a hiatal hernia.
Symptoms
The common symptoms of a hiatal hernia causing acid reflux (GERD) include heartburn, acid reflux (regurgitation of stomach acid into the esophagus or mouth), chest pain, difficulty swallowing, belching, bloating, sore throat or hoarseness, and sometimes shortness of breath if the hernia presses on the lungs. In severe cases, symptoms may progress to vomiting blood or black stools due to complications like bleeding [1][2][4].
Diagnosis
Diagnosing a hiatal hernia typically begins with a clinical evaluation of symptoms. Imaging studies are then used to confirm the hernia, which may include a barium swallow X-ray, upper endoscopy (esophagogastroduodenoscopy, EGD), esophageal manometry, or pH monitoring [4][5].
Treatment
Treatment options for a hiatal hernia depend on symptom severity. For mild to moderate symptoms, lifestyle modifications and medications such as antacids, proton pump inhibitors, and H2 blockers can help reduce acid reflux and heartburn. However, for severe symptoms unresponsive to medication, surgical repair (hiatal hernia repair surgery) may be considered. This often involves repositioning the stomach, tightening the hiatus, and wrapping the stomach around the lower esophagus (fundoplication) to prevent reflux [3][4].
Risk Factors and Prevention
Several factors can increase the risk of developing a hiatal hernia, including age, gender (females are more susceptible), conditions that increase pressure in the abdomen (such as obesity, chronic constipation, chronic obstructive pulmonary disease, genetics, trauma to the abdomen, or previous surgery), and smoking [1][2][3]. Preventive measures include quitting smoking, maintaining a healthy weight, and avoiding foods and drinks that exacerbate GERD symptoms, such as citrus fruits, tomatoes, chocolate, alcohol, caffeine, high-fat foods, spicy foods, mint, and acidic foods [1].
Living with a Hiatal Hernia
Elevating the head by 6-8 inches while sleeping can help reduce acid reflux symptoms. In some cases, a surgical procedure called fundoplication may be performed to repair a hiatal hernia, where a surgeon wraps the top section of the stomach around the lower part of the esophagus [3]. While surgery is often successful in relieving acid reflux symptoms, recurrence of the hernia can occur many years later and may require further intervention [3].
References
[1] Mayo Clinic. (2021). Hiatal Hernia. Retrieved from https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20351183
[2] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). GERD. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/gastroesophageal-reflux-disease
[3] Cleveland Clinic. (2021). Hiatal Hernia. Retrieved from https://my.clevelandclinic.org/health/diseases/16649-hiatal-hernia
[4] American College of Gastroenterology. (2021). Hiatal Hernia. Retrieved from https://www.acg.org/patients/disease-information/hiatal-hernia
[5] University of California, San Francisco. (2021). Diagnosis of Hiatal Hernia. Retrieved from https://www.ucsfhealth.org/education/diagnosis-of-hiatal-hernia/articles/21271/diagnosis-of-hiatal-hernia
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