Tuesday, August 29, 2006

hiatal hernia : Associated Diseases

Associated Diseases
Barrett’s oesophagus - 96% of Barrett’s oesophagus patients have a hiatus hernia3
Oesophageal adenocarcinoma - increase in risk x6 with hiatus hernia but no reflux and x8 if reflux as well.4

Non-Drug Patients with hiatus hernia should be advised to avoid any factors likely to increase intra-abdominal pressure e.g. tight clothing, corsets.

Nocturnal symptoms may be helped by elevating the head of the bed to reduce postural reflux.

Weight loss should be advised in obese patients and patients who smoke and /or drink should be encouraged to stop.

Drugs Symptomatic relief may be gained by the use of alginates +/- use of proton pump inhibitors, although patients with hiatus hernia may require larger doses for symptom control.

Surgical The presence of a hiatus hernia is a marker for severe GORD .Patients with a hiatus hernia tend to have more severe symptoms and a poorer response to treatment, but it’s presence per se does not alter management strategies.

Indications for surgery in patients with severe GORD include:-

Patients who are unable to comply with therapeutic regimes
Patients who require high doses of drugs
Patients who wish to avoid lifelong medical treatment
The surgical procedure most commonly used involves mobilising the oesophagus in the thorax, bringing it down to restore the intra-abdominal portion and repairing the deficit (modified Nissen procedure).

Oesophageal lengthening combined with fundoplication may be performed during laparoscopic surgery.

Several novel endoscopic techniques have been used in the treatment of GORD with some success, but the results do not separate out patients with hiatus hernia.

Prognosis The majority of patients will gain symptomatic relief from medical or surgical intervention, although a few will go on to develop Barrett’s oesophagus or oesophageal adenocarcinoma.

© EMIS and Patient Information Publications 1997-2006

hiatal hernia : Epidemiology

Incidence The precise incidence of hiatus hernia is not known, as most studies have looked only at individuals who presented with symptoms of dyspepsia. Of patients undergoing investigation for dyspepsia in western populations approximately 15-25% are discovered to have a hiatus hernia.2 Males and females appear to be equally affected. The incidence increases with age and obesity but varies from country to country being more common in western societies and rare in the Far East.

The term hiatus hernia refers to the herniation of a part of the abdominal viscera through the oesophageal aperture of the diaphragm. The vast majority of hiatus hernias involve only the herniation of a part of the gastric cardia through the muscular hiatal aperture of the diaphragm, however rarely, hernias with a large defect can allow other organs to enter the thoracic cavity such as spleen and pancreas. A hiatus hernia may be caused by one or more of 3 possible mechanisms i) widening of the diaphragmatic hiatus. ii) pulling up of the stomach due to oesophageal shortening. iii) pushing up of the stomach by increased intra-abdominal pressure.1 The association between hiatus hernia and oesophagitis has been recognised for over 70 years, however it is only much more recently that the precise relationship between the two has been understood. It is now believed that the hiatus hernia has major pathophysiological effects resulting in gastro-oesophageal reflux and contributing to mucosal injury, particularly in patients with severe Gastro-oesophageal reflux (GORD or GERD)

Presentation Many individuals with a hiatus hernia will be totally asymptomatic, others may present with any of the following:-

Retrosternal burning sensation or "Heartburn" especially on bending or lying
Gastro-oesophageal reflux
Large hernias may cause difficulty in swallowing (rare)

Investigations Barium studies remain the only accurate method of measuring the size of a hiatus hernia

Upper GI endoscopy although commonly used for assessing symptoms of dyspepsia, it is not useful for assessing a hiatus hernia due to difficulties with measurement.

Oesophageal manometry, is not sufficiently sensitive for diagnostic purposes especially with small hernias

© EMIS and Patient Information Publications 1997-2006

hiatal hernia : Taming a Hiatal Hernia?

A hiatal hernia is a protrusion of a portion of the stomach through the muscular ring at the junction of the esophagus and stomach. Usually, this common occurrence causes no symptoms, but sometimes the lining of the protrusion becomes inflamed, causing heartburn, belching, distention, problems swallowing, and regurgitation.

For relief, I recommend deglycyrrhizinated licorice (DGL), which can soothe the lining of the esophagus and stomach. Chew two tablets slowly before each meal or between meals, or take one-half teaspoon of the powder before meals. Let it slowly trickle down your throat. You can continue to use DGL as long as you have symptoms. Here are some other lifestyle changes that can help:

Reduce or eliminate alcohol consumption. If you do take an occasional drink, be sure to eat something first.
If you smoke, stop -- tobacco can irritate the digestive system.
Avoid coffee and decaffeinated coffee. Caffeine can aggravate symptoms. Substitute chamomile tea, which is soothing.
Experiment with foods to see which ones trigger your symptoms and avoid any that do.
Don’t eat within two to three hours of bedtime, and don’t lie down after meals.
Eat frequent small meals rather than three large ones.
Elevate the head of your bed by six to eight inches (to prevent stomach acid from refluxing while you’re lying down).
You should also try to avoid drugs that can make reflux worse by decreasing the pressure of the lower esophageal sphincter. These drugs include calcium channel blockers, nitrates, sedatives, and theophylline. Peppermint can have the same undesirable effect.

Conventional doctors probably will prescribe acid-suppressive drugs. I recommend using them only short-term or not at all, as they have significant side effects, are not intended for long-term use, treat the problem superficially, and cause rebound increase in acid production when you stop taking them.

Dr. Andrew Weil

Wednesday, August 23, 2006

hiatal hernia : Causing Strain on Bowel or Kidneys

Hernia occurs when the abdominal wall structure ruptures or an opening takes place there. As a consequence thereof, the wall of the abdomen is destroyed and there is an outcropping via that membrane which is rather thin. The outcropped parts are mainly sections of the fatty tissue that make up the abdomen or certain parts of the intestine (small and large). Mention may be made of Hiatal hernia which happens when the tummy comes out through the diaphragm and rises till the chest. However, hernia can happen anywhere in the human body.

Hernias can lead to pain in the chest besides heartburn. Moreover, hernias can stop blood flow to that affected part, and during such abnormal situations surgeries are the only ways out.

Hernia can be of the following types: Indirect, Direct, Inguinal, Obturator, Spigelian, Umbilical, Incisional and Femoral. Hernia can be caused by many factors. The main ones are obesity, coughing, weight lifting exercises, lung ailments, exertion of pressure on the abdomen during pregnancy and the presence of hernia in the umbilical cord which may then pass on to the baby.

Hernia can occur if anyone keeps on putting too much of strain on the bowel or the kidneys during bowel movement or urination during Straining during a bowel movement or urination. Moreover, hernia may take place if there is too much of fluid in the cavity that makes up the abdomen.

Different types of hernia have different sets of symptoms. The commonly reported symptoms of hernia are belching, heartburn – especially when one lies down or while bending -- chest pain, groin pain during bending, groin soreness, appearance of lump which may be painless, esophagus blockage, swallowing problems, and/or protrusion(s) that may be just tender or swollen for that matter.

If hernia is diagnosed, strictly follow your physician’s schedule. Some of the commonly prescribed methods to check hernia is to say ‘NO’ to depression, cut down on the regularly taken diet, avoid non-digestible food items, quit smoking or/and alcoholic substances, never to lie down or even bend after meals, and avoid tight-fitting clothes. Moreover, ensure that you do not exert pressure on the abdomen while coughing and stop lifting heavy articles.

The best way to control hernia is to consume fibery items like grains (including millet and barley), vegetables (sweet potatoes, cabbage, artichoke, and dandelion), herbs (aloe vera, arrowroot, parsley, mint, asafetida, cumin, fennel, among others) and lots of fruits. To prevent constipation and thus obviate the possibility of putting undue pressure on the intra-abdominal area is to increase the amount of liquids especially water. Take to regular exercise. Sweating can also help excrete toxic items from the body. Go for six meals in lesser amounts instead of three large meals. But, remember to not consume such items you may be allergic to. Moreover laugh away your blues by enrolling yourself in the local laughter club.

One of the popular remedies for hernia is to consume Cayenne pepper, sweating out a lot by either exercising, brisk walking, or by drinking tea (warm) in a room that is hot. One can also get relief from hernia by placing a rupturewort tea-soaked cloth on the portion that is affected.

by Nilutpal Gogoi

hiatal hernia : All About Acid Reflux

Acid reflux is scientifically known as Gastroesophageal Reflux Disease (GERD). It is a disease characterized by the abnormal reflux of gastric contents into the esophagus resulting to chronic symptoms or mucosal damage.

Acid reflux is often caused by temporary or permanent alterations in the lining that separates the esophagus and the stomach. Ineffectiveness of the lower esophageal sphincter (LES) or a temporary LES relaxation connected with a hiatal hernia are just some of the common causes of acid reflux. The process can also lead to a backflow of gastric juices to the pharynx or mouth.

Among adults, the most common symptom of acid reflux is heartburn which is caused by the presence of acid in the esophagus. Heartburn is characterized by a painful burning sensation behind the sternum or breastbone. Another symptom or manifestation of acid reflux is esophagitis which is characterized by an inflammation of the lining of the esophagus which is also known as the mucosal lining. Esophagitis also causes swallowing difficulties and chronic pains in the chest area.

Sometimes, individuals suffering from acid reflux may also experience coughing, persistent pain in the ears, hoarseness or a change in the voice and even sinusitis. If acid reflux gets complicated it may lead to formation of a stricture or ulcers in the esophagus. It may also lead to a condition called Barrett’s esophagus and in worst cases to cancer of the esophagus.

It doesn’t mean however that a person who regularly suffers from heartburn is suffering from acid reflux. By all means, the heartburn may be from other causes. But if a person suffers from heartburn for more than once a week, then he or she is at a risk of acquiring acid reflux. Person with hiatal hernia are also at a greater risk in developing acid reflux than those who are not.

By Robert Thatcher

Tuesday, August 15, 2006

hiatal hernia : Heart Burn and Indigestion

There are many people who suffer from the symptoms of heart burn and indigestion. These symptoms may result from the foods we eat, the beverages we drink or our lifestyles, but symptoms of burn heart indigestion may also be related to other medical conditions and chronic symptoms should be reported to your doctor. Choosing a burn heart medication is a choice to be made by you and your doctor. Here is a look at some of the common heart burn medications and the side effects associated with them.

One of the most highly advertised heart burn medications is Prevacid. Prevacid burn heart medication should not be used by persons with liver disease or certain allergies. You have probably seen the commercials and may have heard the side effects associated with this popular treatment for burn heart indigestion. If your heart burn symptoms are mild, the side effects may not seem worth it. Constipation or diarrhea may occur when using Prevacid.

Another common burn heart medication is Pepcid. It should not be used by persons with liver problems, kidney disease, stomach cancer or those with certain allergies. Side effects that may be experienced include headache, constipation, diarrhea or dizziness. There are serious side effects that are rare, but have occurred in persons using Pepcid to treat burn heart indigestion symptoms.

Prilosec is a prescription medication used to treat heart burn symptoms. Users of this burn heart medication may experience constipation, cough, dizziness or back pain.

Any over the counter or prescription burn heart medication may cause unwanted side effects. Only you and your doctor can decide if the benefits outweigh the possible risks. The symptoms of burn heart indigestion may be relieved by certain botanicals or health supplements and possibly prevented changing the diet and lifestyle.

Some people who experience chronic symptoms of burn heart indigestion have other more serious diseases which may not be relieved by changes in eating habits or lifestyle. These include acid reflux disease, hiatal hernia and diseases of the esophagus. In addition, any non-burning chest pain, pressure, heaviness or nausea associated with chest pain could be related to the heart, rather than the throat and stomach. It is important to err on the side of caution whenever chest pain is involved. It could be simple burn heart indigestion or something much more serious.

By Patsy Hamilton

hiatal hernia : Heart Burn Remedies

There are many heart burn remedies on the market. There are many heart burn home remedies, as well. Any may be effective. Here we look at some of each.

Heartburn is a burning sensation in the throat or chest that may or may not be accompanied by gas or bloating. It happens when stomach acid, which is normally confined to the stomach, bubbles up or leaks into the esophagus and is also referred to as indigestion. Effective heart burn remedies neutralize the acid and soothe the burning sensation. Some heart burn remedies will also relieve the gas and bloating. Many over the counter heart burn remedies contain calcium carbonate. One popular product even advertised itself as an effective calcium supplement. Effective heart burn home remedies include using peppermint or other mints to relieve the symptoms. Most over the counter heart burn remedies are mint flavored, but not all contain peppermint oil. The ones that do may be more effective in relieving gas and other symptoms of indigestion.

It is not uncommon to experience heartburn symptoms after a very large meal. These meals often make one feel sluggish as well, but taking a nap may bring on or worsen heart burn symptoms. Some people find that heart burn home remedies are unnecessary if they take a leisurely slow or sit quietly for a while following the meal. Even after symptoms are present, relaxing in a sitting position or strolling around the neighborhood may be effective heart burn home remedies.

Over the counter heart burn remedies include antacid products like Tums or Rolaids. There are other products that will relieve gas and bloating. Calcium carbonate is usually effective for neutralizing the stomach acid, but may leave a chalky taste in the mouth. Products that contain mint oil or peppermint may be a little harder to find, but will leave a pleasant taste in the mouth. Heart burn home remedies containing fennel and other herbs have been used by Native Americans and Europeans alike to relieve the symptoms of indigestion. It is possible to make a soothing tea using fennel seeds. Drops containing fennel and other herbs are also available from companies that sell natural products. Relief may also be found in chewing on a piece of rhubarb or non-fruit flavored gum. The saliva created by the chewing action will help neutralize the acid. Smoking will worsen the heartburn symptoms, because it dries out the saliva in the mouth and throat. Experiencing frequent heartburn is one of many reasons to quit smoking.

Chronic heart burn may be a symptom of another more serious medical condition. For instance, a hiatal hernia pushes up against the stomach, causing the stomach acid to leak up into the esophagus. Anyone experiencing symptoms of heartburn more than once a week should have their symptoms evaluated by a physician. Heartburn may be a result of stress, overeating, drinking too much coffee or eating fried or acidic foods, but if heart burn remedies do not provide relief or if the heartburn is frequent, it could mean something else is going on.

By Patsy Hamilton

Tuesday, August 08, 2006

hiatal hernia : Ways to Reduce Heartburn

There are many ways to reduce heartburn frequency. There are some pretty safe foods for heartburn sufferers. However, it may be necessary to evaluate your lifestyle and overall health in order to prevent the frequency of heartburn. Sometimes it is necessary to keep a food diary or at least a mental note of what foods you ate before you experienced the heartburn symptoms. Most people experience heartburn occasionally. It is next to impossible to avoid everything that can cause heartburn all the time, but there are ways to reduce heartburn or at least the likelihood of experiencing heartburn symptoms.

Some ways to reduce heartburn include dietary changes. If your diet is high in fat and acidic foods like tomatoes and citrus fruits, reducing this and including more safe foods for heartburn sufferers may reduce the frequency of your heartburn. Experts may not always agree on what are safe foods for heartburn sufferers, but most agree that they are foods that are low in fat and low in acid. For instance, apples, bananas and pears are better choices than oranges. Baked, grilled or boiled skinless, white meat chicken and baked, boiled or broiled seafood are better choices than hamburgers and fried chicken. It is a sensible diet that you are looking for, not just a list of safe foods for heartburn sufferers.

Most treatment plans or recommended ways to reduce heartburn include lifestyle changes along with dietary changes. For example, eating several small meals every couple of hours is better than eating one or two large meals. Even if you only eat supposed safe foods for heartburn sufferers, but you overeat, you may experience heartburn. If you are overweight, eating smaller meals more frequently may help you lose weight by increasing your metabolism and maintaining proper blood glucose levels. People who are overweight suffer from heartburn more frequently than people who are at their ideal weight, so losing weight may be one of the ways to reduce heartburn.

If you experience heartburn at night, one of the ways to reduce heartburn is to eat your last meal three to four hours before going to bed. Elevating the head of your bed or sleeping on a specially designed wedge are other possible ways to reduce heartburn that is experienced at night. Overweight people are more likely to experience heartburn at night, it may interfere with their sleep or they may be unaware of it. Nighttime heartburn can lead to respiratory problems, as the acid can be inhaled. If you are eating small meals, trying to lose weight and including mostly safe foods for heartburn sufferers in your diet, but you know or believe that you are suffering from nighttime heartburn, it is advisable to see your doctor, before the problem becomes worse.

All of the above recommendations for ways to reduce heartburn assume that a person is in otherwise good health. Heartburn can be a symptom of more serious medical conditions including acid reflux and hiatal hernia. Treatment plans still generally include the above mentioned lifestyle changes and eating more safe foods for heartburn sufferers, but other medications may be recommended.

by Patsy Hamilton

Monday, August 07, 2006

hiatal hernia : Diet For Heartburn

Heartburn is a common digestive complaint which affects an estimated 15 million Americans every day, and 60 million once a month. Relief of mild heartburn is typically achieved through diet and lifestyle changes, although medication (eg. antacids) is usually necessary if the heartburn is caused by gastroesophageal reflux disease (GERD).

What is Heartburn? What Are The Symptoms?

Heartburn is a digestive problem: it has nothing to do with your heart. It occurs when small amounts of stomach acid accidentally rise up the esophagus (the food canal running from the mouth to the stomach) causing symptoms like a burning pain in the chest which rises towards the throat. Sufferers may even taste the fluid in the back of the mouth, and this is called acid indigestion. In many cases the pain and burning sensation is relatively mild, but sometimes is so severe that patients think they are experiencing a heart attack.

What Are The Causes Of Heartburn?

In general, the immediate cause of heartburn is the acidic digestive juices which leave the stomach and rise up the esophagus. The acid burns the tissue of the esophagus causing inflammation and pain - a condition called esophagitis. Heartburn may also occur in pregnancy when the baby is pressing up against the underside of the diaphragm and squeezing the stomach. An occasional episode of acid-regurgitation or indigestion is quite normal. But persistent heartburn (eg. twice a week), is usually a sign of something more serious. The two most common underlying causes of heartburn symptoms are gastroesophageal reflux disease (GERD), and hiatal hernia.

Gastroesophageal Reflux Disease

GERD is characterized by a failure of the muscular valve, known as the lower esophageal sphincter (LES), which is located at the bottom of the esophagus. The function of this valve is to keep acid in the stomach and prevent it leaking back up the esophagus. When this valve doesn't work properly, reflux (leak-back) and heartburn can occur. Factors that contribute to gastroesophageal reflux disease include obesity, pregnancy, smoking and, in particular, hiatal hernia.

Hiatal Hernia

Hiatus or hiatal hernia is a condition in which part of the stomach herniates (protrudes) upwards into the chest through the hiatus (opening) in the diaphragm normally only occupied by the esophagus. This puts extra pressure on the LES valve preventing it from closing properly. As a result, stomach acid leaks into the esophagus causing heartburn. The underlying cause of hiatal hernia is unknown. Contributory factors include: obesity, pregnancy, constipation, abdominal muscle strain, and smoking.

Dietary Treatment For Heartburn

In cases of persistent heartburn, dietary improvements are not sufficient. So as well as advocating a digestion-friendly diet, your doctor is likely to recommend one or more of the following types of medication. Antacids to neutralize the acid in your stomach; H2 blockers or proton pump inhibitors to reduce acid production; or prokinetics to strengthen the lower esophageal sphincter and expedite stomach-emptying. However, if heartburn symptoms are mild and occur only from time to time, usually you will be advised to make the following changes to your diet.

If Overweight, Switch To A Healthy Weight Loss Diet

Obesity, especially excess fat on the chest and abdomen, is a common contributory factor to GERD and hiatal hernia, and therefore to heartburn. So if you are obese (BMI > 30), take steps to normalize your weight and thus reduce your risk or symptoms of heartburn. Choose a healthy calorie-controlled diet and customize it by following the eating tips below.

Stop Eating Large Meals

A big meal distends the stomach and causes a rise in the production of stomach acid. Both these factors lead to an increased risk of heartburn. So opt for 4-6 small meals or snacks, and allow a maximum of 3 hours between eating. In addition, choose foods that are "easier on the stomach" and more more easily digested.

Avoid Acidic Food

Reduce your intake of very acidic foods by avoiding items such as: tomatoes, tomato-based sauces, citrus fruits, rhubarb, gooseberries, unripe fruit, vinegar and acidic pickles or relishes.

Cut Down On Fatty and Spicy Food

Fried or very fatty foods, including candy, encourage indigestion and should be avoided or eaten sparingly. So go easy on butter, mayo, sausages, salami, pate, meat pies, and full-fat cheese. The same applies to very spicy food such as: black pepper, chili peppers, curry, mustard and other hot spices, as well as raw onions and garlic.

Avoid Carbonated Drinks

Fizzy or carbonated soft drinks cause belching and upward pressure on the lower esophageal sphincter (LES), increasing the likelihood of heartburn. The best drinks include: water, herbal teas or diluted non-citrus fruit juices. Please also note that some soft drinks (eg. cocoa, coffee, orange juice) are not helpful for heartburn as they can over-relax the LES, thus encouraging the backward flow of acid from the stomach.

Eat More Fiber, Especially Soluble Fiber

Constipation can lead to extra strain on abdominal muscles and increase the risk of heartburn. To prevent constipation, eat more high-fiber foods such as: oats, apples, pears, dried apricots and vegetables. When increasing fiber intake it's also important to increase your water intake by at least 40 fl oz a day.

Reduce Alcohol Consumption

Alcohol is not helpful to heartburn for several reasons. So take steps to reduce your intake to one unit a day, or avoid it altogether. Alcohol is also a source of non-nutritious calories and can contribute to overweight.

Other Digestive Tips

For digestive disorders like heartburn, some dietitians and alternative health experts recommend patients to eat (or cook with) digestion-friendly aromatic herbs like basil, camomile, caraway, dill, fennel, rosemary and thyme. They also recommend that you end each meal with a glass of herbal tea (eg. camomile, fennel) to reduce acidity and wind.

Lifestyle Improvements To Reduce Heartburn

There are several lifestyle changes that can help to reduce the symptoms of heartburn. One obvious one is to stop smoking, as tobacco smoke increases acidity in the stomach. Other recommended changes include:

Avoid placing extra strain on your abdomen or chest. Wear loose-fitting clothes, and do not overstretch or lift heavy weights.

Do not lie down after eating, and try not to eat anything for at least three hours before going to bed. The less there is in your stomach when you come to lie down, the lower the risk of heartburn.

To minimize night-time discomfort, raise the head end of your bed by about 3 inches by using bed-blocks or by placing a solid object under the bed-legs. This helps to prevent stomach acid from leaking backwards into the esophagus. Do not use extra pillows - you simply end up with a stiff neck as well as heartburn!

Heartburn symptoms can be caused by certain over-the-counter drugs, such as aspirin, or other pain-killers or anti-inflammatories. So if you take this type of medication regularly, check with your doctor or pharmacist that it's safe to continue.

By Linda Smyth

Wednesday, August 02, 2006

hiatal hernia : What Are The Symptoms And How Does It Cause GERD?

The symptoms of a hiatal hernia

The vast majority of hiatal hernias are 'sliding' hiatal hernias in which the junction of the esophagus and stomach, referred to as the gastroesophageal junction, and part of the stomach protrudes into the chest. The larger the hernia, the more likely it is to cause symptoms. When hiatal hernias produce symptoms, they are almost always those of gastroesophageal reflux disease (GERD) or its complications.

This happens because the formation of the hernia often interferes with the barrier (lower esophageal sphincter) which prevents acid from refluxing from the stomach into the esophagus. Patients with GERD are more likely to have a hiatal hernia than individuals not afflicted by GERD. Although hiatal hernias contribute to GERD, it is not clear if hiatal hernias alone can result in GERD. Since GERD occurs in the absence of a hiatal hernia, factors other than the existence of a hernia can cause GERD.

How a hiatal hernia causes GERD

GERD is when acid flows backwards (refluxes) up into the esophagus. Normally, there are several devices to prevent this from happening.

One device involves a band of esophageal muscle, where the esophagus joins the stomach. This is called the lower esophageal sphincter; it remains contracted most of the time to prevent acid from refluxing or regurgitating.

The sphincter only relaxes when food is swallowed so that the food can pass from the esophagus and into the stomach. The sphincter is normally attached firmly to the diaphragm in the hiatus, and the muscle of the diaphragm wraps around the sphincter. The muscle that wraps around the diaphragm increases the pressure of the contracted sphincter to further prevent reflux of acid.

Another device that prevents reflux is the valve-like tissue at the junction of the esophagus and stomach just below the sphincter. The esophagus normally enters the stomach logically so that there is a sharp angle between the esophagus and stomach. The thin piece of tissue in this angle, composed of esophageal and stomach wall, forms a valve that can close off the opening to the esophagus when pressure increases in the stomach; during a belch, for instance.

When a hiatal hernia is present, two changes happen:

The sphincter slides up into the chest while the diaphragm remains stationery. As a result, the pressure normally generated by the diaphragm overlying the sphincter and the pressure generated by the sphincter no longer overlap. As a result, the total pressure at the gastroesophageal junction decreases. When the gastroesophageal junction and stomach are pulled up into the chest with each swallow, the sharp angle where the esophagus joins the stomach becomes less sharp and the valve like effect is lost.

Both changes promote reflux of acid, or GERD.

Hope for Hiatal Hernia!

Understanding the processes behind a hiatal hernia and GERD is the first step to treating it.

By Nick Willis

hiatal hernia : What Is It?

A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.

Normally, the esophagus or (food tube) passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach.

In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they have probably been present from birth, most hiatal hernias in adults are believed to have developed over many years.

The Causes of a Hiatal Hernia.

It is thought that hiatal hernias are caused by a larger than normal esophageal hiatus, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen. As a result of the large opening, part of the stomach "slips" into the chest.

Other contributing factors include:

A permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid), which pulls the stomach up.

An abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.

Different Types of Hiatal Hernias.

Hiatal hernias are either:


Sliding hiatal hernias are those in which the junction of the esophagus and stomach, referred to as the gastro esophageal junction, and part of the stomach protrudes into the chest.

The junction may reside permanently in the chest, but often it juts into the chest only during a swallow. This occurs because with each swallow the muscle of the esophagus contracts causing the esophagus to shorten and to pull the stomach up.

When the swallow is finished, the herniated part of the stomach falls back into the abdomen.


Para-esophageal hernias are hernias in which the gastro-esophageal junction stays where it belongs (attached at the level of the diaphragm), but part of the stomach passes or bulges into the chest beside the esophagus. The para-esophageal hernias themselves remain in the chest at all times and are not affected by swallows.

A para-esophageal hiatal hernia that is large, particularly if it squeezes the adjacent esophagus, may hamper the passage of food into the stomach and cause food to stick in the esophagus after it is swallowed. Ulcers also may form in the herniated stomach due to the disturbance caused by food that is stuck or acid from the stomach.

Fortunately, large para-esophageal hernias are uncommon.

Hope for Hiatal Hernia!

Once you grasp the 'biology' behind a hiatal hernia, you can begin to understand the science behind some deceptively simple techniques to manage the condition. To find out more, check my review of my recommended resource on controlling a hiatal hernia.

by Nick Willis