Hiatal hernia

Hiatal hernia: Description, Causes and Risk Factors: Abbreviation: HH. Hernia of a part of the stomach through the esophageal hiatus of the diaphragm. Hiatal herniaYour diaphragm is a large dome-shaped muscle that separates your chest cavity from your abdomen. Normally, your esophagus passes into your stomach through an opening in the diaphragm called the hiatus. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of your stomach bulges up through the diaphragm into your chest cavity. Types May Include:
  • Type I: Sliding.
  • Type II: Paraesophageal ("rolling").
  • Type III: Combined I & II.
The cause is unknown, but hiatal hernias may be the result of a weakening of the supporting tissue. Increasing age, obesity, and smoking are known risk factors in adults. Children with this condition are usually born with it (congenital). It is often associated with gastroesophageal reflux in infants. Hiatal hernias are very common, especially in people over 50 years old. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus. Risk Factors:
  • Weak esophageal muscles which can result from aging, cancer, injury, certain surgeries, or an inherited flaw in formation of the diaphragm. It is often associated with gastroesophageal reflux (GERD) in infants.
  • Increased abdominal pressure that occurs during bending, straining, coughing, extreme physical exertion, or wearing tight clothing that can cause the stomach and esophagus to push into the chest.
  • Increased abdominal fluid accumulation, pregnancy, and obesity can also contribute.
  • Repetitive straining to have a bowel movement or to urinate.
  • Chronic coughing.
  • Obesity.
  • Heavy lifting with poor body mechanics.
  • Smoking history.
Symptoms: Symptoms may include:
  • Heartburn 1-4 hours after eating which increases with lying down.
  • Swallowing difficulty.
  • Belching.
  • Abdominal pressure.
  • Possible vomiting.
  • Epigastric pain.
  • Chest pain.
  • Postprandial fullness.
  • Dysphagia.
  • Abdominal bloating.
  • Respiratory symptoms.
Diagnosis: Diagnosis May Include: Barium X-ray (Barium Swallow): This test requires the patient to drink a small amount of liquid containing barium. The barium shows up clearly on an x-ray, allowing the radiologist to clearly see if a portion of the stomach is out of place in the chest cavity. Endoscopy (EGD): During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation. Treatment: Most hiatal hernias do not require management. The goals of treatment are to relieve symptoms and prevent complications. Reducing the backflow of stomach contents into the esophagus will relieve pain. Medications that neutralize stomach acidity, decrease acid production, or strengthen the lower esophageal sphincter may be prescribed. Medications may include:
  • Antacids that neutralize stomach acid: Over-the-counter antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief. But antacids alone would not heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
  • Medications to reduce acid production: These medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 75). H2-receptor blockers do not act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
  • Medications that block acid production and heal the esophagus: Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Stronger versions of these medications are available in prescription form.
You may also benefit from changes in your diet, such as limiting acidic foods (tomato and lemons, etc) and by refraining from eating immediately before bedtime. If you experience severe heartburn at night, you may also benefit from elevating the head of your bed 30 degrees. For larger hiatal hernias surgery may be performed. Hiatal hernia surgery is typically performed using general anesthesia and can be done on an inpatient or outpatient basis. The surgery is typically performed by a general surgeon. Preventive Measures:
  • Avoiding large or heavy meals.
  • Not lying down or bending over immediately after a meal.
  • Reducing weight and not smoking.
Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  

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