A B C D E F G H I J K L M N O P R S T U V W

HIATUS HERNIA

What is a Hiatus Hernia ?

A hiatus hernia occurs when part of the stomach is located within the lower chest rather than just within the abdomen. A hiatus hernia is very common and for many individuals does not give rise to any problems at all. There are different types of hiatus hernia but the commonest is called a ‘sliding’ hiatus hernia. The hernia itself is not dangerous in any way but once it has formed the mechanisms which normally prevent stomach contents from regurgitating into the gullet (oesophagus) are less effective. It is important to appreciate that it is not the hernia itself which gives rise to symptoms and it is for this reason that the term gastro-oesophageal reflux disease (GORD) is often used for those patients who have symptoms. The typical symptom caused by this regurgitation of food and acid from the stomach is discomfort behind the breast bone which is called heartburn. Heartburn occurs commonly after a large meal, when bending over or when lying flat. There may also be a bitter taste in the mouth and this is called waterbrash. If the acid damages the lining of the lower part of the gullet then this is called oesophagitis but there is surprisingly little correlation between the amount of heartburn and the degree of oesophagitis. If oesophagitis is severe however, there may be pain on swallowing and eventually difficulty swallowing as the oesophagus becomes scarred and narrowed. Oesophagitis can cause bleeding but this is not usually severe. In a small number of patients the reflux of acid into the gullet, particularly at night, can lead to acid irritating the upper airways and precipitate asthma.

How does a Hiatus Hernia occur ?

The symptoms of reflux are much more likely to occur in individuals who are obese. There is a complex mechanism in place which prevents regurgitation and this is altered in obesity, and any other condition which affects the pressure within the abdomen. Reflux is also more common during pregnancy. It is often unclear as to why the hiatus hernia has formed.

Why does a Hiatus Hernia occur ?

This may be unclear but in addition to a hiatus hernia which may promote reflux some foods such as citrus fruits, bananas or chocolate and some drinks such as colas, coffee or alcohol containing drinks are likely to make the symptoms worse. Symptoms are also made worse by smoking.

Treatment Involved for a Hiatus Hernia

For many people the diagnosis may be clear from the outset and further teats may not always be needed. If however the individual is older than 45 years of age it is often recommended that further tests should be performed to exclude other potentially more serious conditions. The presence of a hiatus hernia is often demonstrated by a barium X-ray. This involves drinking a special liquid which shows up on X-rays taken whilst drinking. Any oesophagitis is more accurately assessed by a telescope examination of the gullet and stomach (an endoscopy). Initial treatment will involve correction of any precipitating factors as indicated above. The symptoms of heartburn are usually readily controlled by medication that either neutralises acid produced within the stomach or prevents the acid being produced. Examples of medicines which help neutralise acid include simple treatments which may be bought from a pharmacy such as antacids (e.g. Gaviscon or Rennies) or acid suppressing drigs such as cimetidine and ranitidine which are more potent. Medicines which also suppress acid production but are obtained on prescription only include omeprazole (Losec) and lansoprazole (Zoton) but there are several others of this type.

During Treatment for a Hiatus Hernia

There is usually a rapid response to the more powerful medications indicated above. Symptoms will typically improve within a few days. Antacids can lead to diarrhoea or constipation. The duration of treatment is dependant upon the severity of symptoms and whether or not there is associated oesophagitis. Your doctor will usually wish to discuss this after the first few weeks of treatment.

After Treatment for a Hiatus Hernia

Some individuals have continuous symptoms and require continuous treatment. Many individuals will only require intermittent treatment, particularly if they can correct any underlying obesity or give up smoking.

If a Hiatus Hernia is Left Untreated

For most people the symptoms are annoying rather than disabling and treatment is not essential. If however there is oesophagitis then this may progress to further damage of the gullet and possible difficulty swallowing.

Effects on Family of a Hiatus Hernia

Your family may be helpful in reminding you of the various measures needed to successfully treat this common problem.