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hiatal hernia

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Hiatal hernia

Hiatal hernia is a condition in which the upper part of the stomach moves into the chest through a hole in the diaphragm. The diaphragm is the muscle that divides the chest cavity from the abdomen.

What is going on in the body?
The oesophagus is the tube that carries food from the mouth to the stomach. It enters the abdominal cavity through a hole in the diaphragm called the oesophageal hiatus. When a person has hiatal hernia, the oesophageal hiatus is usually weakened or larger than usual. At times, the upper part of the stomach can pass up through this larger-than-usual hole and into the diaphragm.

What are the signs and symptoms of the condition?
A person with a hiatal hernia often has no symptoms, and the hernia may be found only during a test called an upper GI series. When symptoms do occur they can include:
  • heartburn
  • painful swallowing
  • burping
  • feeling like food is stuck in the throat
  • feeling of fullness in the chest
  • chest pain
  • blood in the stools
  • severe pain from constriction of the stomach or oesophagus
What are the causes and risks of the condition?
A hiatal hernia may be caused by:
  • constant, harsh coughing
  • vomiting
  • constipation and straining during bowel movements
  • sudden physical exertion
  • pregnancy
  • obesity
  • smoking
  • tight clothing around the abdomen
  • trauma, causing a hole or tear in the diaphragm
  • congenital abnormality, or weakness of the oesophageal hiatus present at birth
  • oesophageal cancer
  • medical procedures affecting the oesophagus or diaphragm
What can be done to prevent the condition?
A person can decrease his or her risk of hiatal hernia by:
  • staying at a healthy weight
  • limiting smoking and alcohol
  • eating a high fibre diet
  • not straining during bowel movements
  • using proper body mechanics, such as bending at the knees, during heavy lifting
  • wearing a seatbelt correctly
  • following sports safety guidelines for children, adolescents, and adults
Some causes of hiatal hernia cannot be prevented.

How is the condition diagnosed?
After a complete history and physical, the doctor may order:
  • ultrasound, a test that uses sound waves to see the diaphragm and stomach
  • endoscopy, a procedure that uses a long tube to look inside the oesophagus
  • an upper GI series. In this test a person swallows liquid barium, and x-rays are taken to follow the course of the barium through the oesophagus and into the stomach.
  • blood tests
  • stool tests and cultures
  • oesophageal motility tests, to evaluate the movement of food and other contents within the oesophagus
  • pH tests to evaluate the acid contents of the oesophagus
What are the long-term effects of the condition?
Hiatal hernias can cause gastro-oesophageal reflux disease (GORD). GORD is chronic heartburn from stomach acid backing up into the oesophagus. Ulcers or irritation of the lining of the oesophagus and upper stomach can also occur. Strangulation of the oesophagus or stomach may also occur with this condition.

What are the risks to others?
Hiatal hernia poses no risk to others.

What are the treatments for the condition?
Treatment of hiatal hernia is focused on treating and reducing symptoms. To reduce symptoms, a person should:
  • sleep with the head of the bed raised 10 to 15 cm
  • avoid citrus fruits, spicy foods, alcohol, smoking, and caffeine
  • eat small, frequent meals
  • maintain a healthy weight, or losing weight if obese
  • avoid eating within 2 hours before bedtime
  • avoid straining during bowel movements or heavy lifting
Medications that block acid production in the stomach or that make the stomach empty faster may help.

Surgery may be needed if symptoms are severe or persistent, or if there is a large hole in the diaphragm. The surgery is done to strengthen the diaphragm and decrease the size of the oesophageal hiatus.

What are the side effects of the treatments?
Medications that block stomach acid production can cause nausea, headache, or diarrhoea. Surgery carries a risk of bleeding, infection, and allergic reactions to anaesthesia.

What happens after treatment for the condition?
For mild intermittent symptoms, treatment with antacids, watching diet and activity may control hiatal hernia. For more serious recurrent symptoms, surgery may be needed. Recovery from surgery may be a few days to several weeks depending on the procedure used.

How is the condition monitored?
Any new or worsening symptoms should be reported to the doctor.

Author: Eileen McLaughlin, RN, BSN
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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