Hiatal hernia
Sutter Davis Hospital Gastroenterology

Definition
A hernia occurs when one part of the body protrudes through a gap or opening into another part. A hiatal hernia forms at the opening in your diaphragm where your food pipe (esophagus) joins your stomach. Part of the stomach pushes through this opening causing a hiatal hernia.  

Causes
The exact cause of hiatal hernias isn't known. 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.  Some people develop a hiatal hernia after an injury to the area. Others are born with an inherent weakness or an unusually large hiatal opening. But anything that puts intense pressure on your abdomen — including persistent or severe coughing or vomiting, pregnancy, straining while going to the bathroom, increased abdominal fluid or lifting heavy objects — can contribute to a hernia.

Symptoms
Most small hiatal hernias cause no problems. Larger hernias may cause the following signs and symptoms when stomach acids back up into your esophagus: Heartburn, Belching, Chest pain and Nausea. These signs and symptoms tend to become worse when you lean forward, strain, lift heavy objects or lie down, and they can also worsen during pregnancy. In rare cases the part of your stomach that protrudes into your chest cavity may become twisted (strangulated) or have its blood supply cut off, leading to: severe chest pain, difficulty swallowing (dysphagia), and obstruction of your esophagus.

Treatment

• Lifestyle Changes:  Several lifestyle changes are recommended to help treat hiatal hernias.  Eating 5-6 small meals a day instead of 3 large meals, not eating or drinking anything 1-2 hours before going to bed, avoiding food that can cause heartburn (spicy foods, fatty foods, foods high in acid), avoiding alcohol and smoking, and avoiding activities that cause abdominal stress.
  
• Medications:  If symptoms persist your caregiver my prescribe the use of medications such as antacids, antagonists, or proton pump inhibitors.
  
• Surgery:  During hiatal hernia repair surgery, the stomach and lower esophagus are placed back into the abdominal cavity, and the hiatus (the opening in the diaphragm where the esophagus and stomach join) is tightened. The upper part of the stomach may also be wrapped around the esophagus to reduce acid reflux.