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Hiatal Hernia
Hiatal Hernia is one of the most misunderstood conditions in medicine.
People blame this hernia for much more than it ever does. Patients with
a hiatus hernia need to understand what it is and what might occur with
it. Most importantly, they need to know it is unusual for serious
problems to develop from this type of hernia.
Anatomy
The diaphragm is a sheet of muscle that separates th e lungs from the abdomen.
When a person takes a deep breath, the dome-shaped diaphragm contracts and
flattens. In doing this, the diaphragm pulls air into the lungs.
The left diaphragm contains a small hole through which passes the
tube-shaped esophagus that carries food and liquid to the stomach.
Normally this hole called a hiatal, is small and fits snugly around
the esophagus. The J-shaped stomach sits below the diaphragm.
What Causes a Hiatal Hernia?
In some people, the hiatus or hole in the diaphragm weakens and enlarges.
It is not known why this occurs.
It may be due to heredity, while in others it may be caused by obesity,
exercises such as weightlifting, or straining at stool. Whatever the cause,
a portion of the stomach herniates, or moves up, into the chest cavity
through this enlarged hole. Hiatus hernia is very common,
occurring in up to 60 percent of people by the age of 60.
What are the Different Types of Hiatal Hernia?
Symptoms
In most patients, hiatal hernia causes no symptoms. This is especially
true of sliding hernias. When symptoms occur, they may only be
heartburn and regurgitation, when stomach acid refluxes back
into the esophagus. Some patients with fixed hiatus hernias
experience chronic reflux of acid into the esophagus,
which may cause injury and bleeding. Anemia, or low red
blood cell count, can result. Further, chronic inflammation
of the lower esophagus may produce scarring and narrowing in this area.
This, in turn makes swallowing difficult, and food does not pass easily
into the stomach.
Does Hiatal Hernia Cause Pain and Indigestion?
It is wrong to always blame a hiatal hernia for pain and indigestion.
Hiatus hernias generally do not cause acute pain. This symptom may
result form other disorders, such as peptic ulcers or even heart
disease. Some patients with coronary heart disease fool themselves
into believing their discomfort is due to a hiatus hernia.
If upper-abdominal pain or indigestion occurs, people should
not mislead themselves into thinking the cause is a hiatal hernia.
Instead, the patient should seek medical advice.
Diagnosis
Diagnosis of a hiatus hernia is typically made through an upper GI barium
x-ray. A complementary test is gastroscopy, or upper-intestinal endoscopy,
in which the physician visually examines the esophagus and stomach using a
flexible scope while the patient is lightly sedated.
What Are the Complications?
The complication of hiatal hernia are:
Chronic heartburn and inflammation of the lower esophagus,
called reflux esophagitis
Treatment
Treatment is called for only when the hernia results in symptoms,
such as persistent heartburn or difficulty in swallowing.
Acid inflammation and ulceration of the lower esophagus also require treatment.
General guidelines for treating heartburn and esophagitis (inflammation of the esophagus) are:
Other Treatment
Summary
A hiatal hernia is an extremely common condition which usually does
not cause symptoms or problems. However, when it does, the physician
can frequently treat the problem effectively with a well-planned program.
Surgery is infrequently required to treat a hiatus hernia.
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