Hiatal Hernias and GERD

Gastrointestinal reflux disease (GERD) impacts nearly one-fifth of all Americans and nearly two-thirds of everyone aged 65 and over. Hiatal hernias are a leading cause of GERD. This condition is actually often left undiagnosed until the patient begins complaining of GERD symptoms.

Simply defined, a hernia is a protrusion of one part of the body through an opening into another part of the body. Hiatal hernias develop when part of the stomach pushes through the opening of your diaphragm where the esophagus joins the stomach. This can result in a weakening of the lower esophageal sphincter, the valve which keeps the contents of your stomach from refluxing into your esophagus.

Often, hiatal hernias are relatively small and benign and don't cause any health issues.  However, if a large hiatal hernia develops, it can let food and stomach acid reflux into your esophagus, causing severe discomfort. If left unchecked, this can eventually result in GERD.

Hiatal hernas fall into two categories, sliding hiatal hernias or para-esophageal hiatal hernias. Sliding hiatal hernias occur when the gastroesophageal junction and part of your stomach move above your diaphragm. This type of hiatal hernias account for 90 percent of all hiatal hernias. Sliding hiatal hernias have a variety of causes. They may occur because the anchors of the esophagus to the diaphragm have become weakened. Longitudinal esophageal muscle contractions, which occur when you swallow, can over many years result in a sliding hiatal hernia. Also, increased abdominal pressure can result in a sliding hiatal hernia. With a sliding hiatal hernia, the gastroesophageal junction and part of your stomach move in and out of place.

A paraespophageal hernia occurs when your gastroesophageal junction stays where it should be, but a portion of your stomach is pushed into your chest alongside your esophagus. These types of hernias are particularly serious because the hernia stays in your chest, which can result in complications. Folks with paraesophageal hernias can suffer from incarceration, which in medical language means that the hernia gets stuck and is squeezed. Incarceration can result in stragulation, or the cutting off of blood to important tissues, resulting in the death of those tissures.

Folks with hiatal hernias often develop GERD because of two changes that impact the lower esophageal sphincter. The lower esophageal sphincter is very important because it prevents the reflux of acid into the esophagus. When the lower esophageal sphincter is weakened or isn't working properly, acid can often reflux into the esophagus. Chronic acid reflux results in GERD, which is characterized by some very uncomfortable symptoms, and can be a precursor to other, more serious conditions such as esophageal cancer.

The two changes occur as follows: First, the lower esophageal sphincter will slide up into your chest while your diaphragm stays in its usual place. This causes a decrease in pressure at the gastroesophageal sphincter. Also, when the gastroesophageal junction and your stomach push up into your chest, the valve in your diaphragm is weakened. These two changes increase the likelihood that you'll experience acid reflux, and eventually GERD.

There are a number of risk factors for hiatal hernias, such as advancing age, obesity and tobacco use. Some other activities and circumstances that may contribute to hiatal hernias include: wearing tight clothing, an abdominal injury, frequent vomiting or pregnancy.

As mentioned before, most people with hiatal hernias have no idea that they have one. About half of all folks who have hiatal hernias never encounter symptoms. Folks who develop GERD generally complain of heartburn, vomiting, regurgitation, gastric reflux and gas. Difficulty swallowing is another GERD symptom that can point toward a hiatal hernial.

Most of the methods used to diagnose a hiatal hernia are similar to those used to diagnose GERD, such as barium x-rays and endoscopy.

The treatment of hiatal hernias also often mirrors that of GERD. Folks with sliding hiatal hernias are usually advised to eat smaller meals, wear loose-fitting clothes, avoid foods and beverages high in acidic content and avoid eating close to bedtime. Hiatal hernia patients are also encouraged to avoid being constipated, as straining can aggravate the hernia.

Paraesophageal hernias are more serious than sliding hiatal hernias and require a more aggressive treatment. Laproscopic surgery is a common treatment. In the surgery, tiny incisions are made in the abdomen, and the surgeon uses a tiny camera inserted in the abdomen to guide small surgical instruments also inserted into the abdomen to correct the hernia by putting the body parts back in their proper place and securing them there.

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