Hiatus Hernia :: Achalasia
A hiatus hernia (also known as a hiatal hernia) occurs when a portion of
slides or protrudes through a gap in the diaphragm (a thin muscle that
stomach from the chest) up into the chest cavity. A hernia is a bulge or
part of the body into another part of the body that would normally contain it.
There are 2 main types of hiatus hernia.
Sliding hiatus hernia: this is the most common type
of hiatus hernia. It occurs when
the junction between the oesophagus and the stomach and the upper part of the
protrude up through the oesophageal opening in the diaphragm into the chest
herniated portion of the stomach can slide back and forth, into and out of the
Rolling hiatus hernia: this is sometimes called a
para-oesophageal hiatus hernia by
doctors. In this case, part of the stomach bulges into the chest out of the
of the diaphragm, which is the oesophageal opening. The junction of the
and stomach stays down within the abdomen, and the top part of the stomach
fundus) bulges up into the chest cavity. This type of hernia normally remains
place, sitting next to the oesophagus, and does not move in or out when you
Most people are not troubled by their hiatus hernia, but if reflux of the
of the stomach occurs (called gastro-oesophageal reflux), you get heartburn.
a painful burning sensation in the chest, which can sometimes be felt in the
Sudden regurgitation of acid fluid into the mouth can occur, especially when
down or bend forward. These symptoms are a problem when you go to bed and can
wake you up. Other symptoms include belching, pain on swallowing hot fluids
feeling of food sticking in the oesophagus.
Treatment is called for only when the hernia results in symptoms, such as
heartburn or difficulty in swallowing. Acid inflammation and ulceration of the
oesophagus also require treatment.
General guidelines for treating heartburn and oesophagitis (inflammation of
- Avoid (or use only in moderation) foods and substances that increase
reflux of acid into the oesophagus, such as:
- nicotine (cigarettes)
- fatty foods
- Eat smaller, more frequent meals and do not eat within 2-3 hours of
- Avoid bending, stooping, abdominal exercises, tight belts, and girdles
of which increase abdominal pressure and cause reflux.
- If overweight, lose weight. Obesity also increases abdominal pressure.
- Prescription medications.
- Elevate the head of the bed 8 to 10 inches by putting pillows or a wedge
under the upper part of the mattress. Gravity then helps keep stomach
acid out of the esophagus while sleeping.
Other Treatments Drugs -- Some medicines
effectively reduce the secretion of
stomach acid, while others increase the muscle strength of the lower
thereby reducing acid reflux.
Surgery -- The complicated hiatus hernia requires
surgery occasionally on an
emergency basis. Surgery otherwise is reserved for those patients with
that cannot be handled with medications. The mere presence of a hiatus hernia
a reason for surgery.