Curved muscular wall – diaphragm – separates the chest cavity from the abdominal cavity, and the esophagus must pass through the opening (hiatus) to reach the stomach.
Hiatus hernia occurs when the muscle tissue around the opening is weakened, so that the abdominal part of the esophagus – often with a part of the stomach – protrudes through the hiatus into the chest cavity. Swelling (or hernia) forms a swelling at the base of the esophagus.
In most cases, hiatus hernias do not cause problems to patient. However, sometimes it may affect the work of a muscular valve (esophageal sphincter) that maintains one-way flow of food from the esophagus to the stomach. In this case acid reflux occurs, i.e. acidic fluid accumulates in the esophagus.
The main symptom is usually heartburn (a feeling that something is ”burning” in your chest). In very rare cases, pain affects both the neck and the arms; if the pain is severe, the patient may mistakenly attribute them to coronary thrombosis. If you bend or lie down, the acid can easily penetrate from the stomach into the esophagus, so the heartburn can be very strong because you lied down.
An additional symptom is throwing up (regurgitation) of gastric acid in the mouth. Burping is common, though it usually comes because the patient ”swallows” the air in an effort to alleviate the pain.
Hiatus hernia is very common, especially among older, obese people. However, symptoms are not present in all cases. Hiatus hernia can also occur in pregnancy.
Hiatus hernia itself is not a difficult or dangerous condition. However, persistent acid reflux, which occurs due to hiatus hernia, can cause inflammation and ulceration of the esophagus. Inflammation in turn may cause strictures of the esophagus (stricture of the esophagus). If ulcers in the esophagus bleed – which is rare, but still possible – anemia can develop.
What to do?
If the symptoms are uncomfortable, apply the suggested self-help measures below. Go to the doctor only if the symptoms persist. In that case, you may need to go to the hospital for diagnostic tests, such as electrocardiography (EKG), radiography, and perhaps endoscopy.
Self-help: the most effective self-help measure is weight reduction. Do not bend, especially after a meal. Do not wear tight cords or belts. Raise the head to about 100 mm to prevent acid reflux at night. Avoid alcoholic beverages that usually make the symptoms worse, and do not smoke because smoking generally exacerbates gastric and digestive problems. Try taking some antacid medication that you can easily get without a prescription in your pharmacy. This will alleviate the symptoms because it will neutralize gastric acid and protect esophageal mucosa. As with the duodenal ulcer, you will be able to alleviate symptoms if you eat several smaller meals during the day instead of just two or three abundant meals.
Professional help: if the antacids you have obtained without a prescription do not help, your doctor may recommend you another type of antacid, i.e. the liquid that you will take after a meal. In order to reduce backflow of acid from the stomach to the esophagus, your doctor may prescribe a medication that accelerates the passage of food through the stomach. With these measures hiatus hernia can be cured; if it takes a while, an operation may be necessary. The operation is relatively simple, and the results are usually good. But, no matter what the treatment is, hiatus hernia will likely come back in obese people.