Hiatal hernia is said to be present when the upper part of stomach protrudes into chest from the abdomen (where it is normally present), through the opening in the diaphragm (the muscular sheet that separates the chest and abdomen). Factors that contribute to it are genetic predisposition, frequent coughing, obesity, smoking, frequently lifting heavy objects or bending over, and straining when passing stools.
Although hiatal hernia might be present in around 15% of people, most of them have only mild or no symptoms. When symptoms do occur, they are mainly regurgitation and heartburn due to acid reflux. There could also be upper abdominal pain or chest pain, difficulty in swallowing, belching, coughing and hiccups. Mild cases require only lifestyle changes and do not require any medical or surgical treatment.
Majority of the cases can be treated with appropriate lifestyle changes and medications. In some cases, a part of the stomach may get lodged permanently in the chest alongside the esophagus (paraesophageal hernia), in which case surgery may be necessary to avoid the risk of strangulation of the herniated portion.
If you are obese, you should lose weight. You should avoid slouching while sitting. Avoid bending over and lifting of heavy objects. Sleep with the head end of the bed at an upward incline of 6-8 inches. Do not sit or recline immediately following a meal; instead, walk around or stand for a while. Eat small meals frequently rather than just 2-3 large meals in a day. Try to eat your dinner 2 hours or more before bedtime. Acid reflux can be controlled by avoiding caffeine, chocolate, spicy foods, fatty or fried foods, smoking, and alcohol.
There are a variety of medications that help treat the symptoms of hiatal hernia. They are discussed below.
Antacids are freely available over-the-counter. They are available as tablets or liquid, for swallowing or chewing. They work by neutralizing the acidity in the stomach. Antacid preparations contain typically salts of aluminium, magnesium or calcium. The side effects they can cause are diarrhea, constipation, vomiting, sick feeling, stomach cramps, and flatulence (wind).
Examples of these are ranitidine, cimetidine, nizatidine, and famotidine. They reduce the acid in the stomach by blocking the chemical called histamine, which is necessary for production of the acid in the stomach. Their side effects include diarrhea, headaches, rash, and tiredness.
These act by blocking the production of acid in the stomach. They include omeprazole, rabeprazole, and lansoprazole. They have mild side effects, including headaches, and diarrhea or constipation.
Surgery is reserved for cases not responding to lifestyle changes and medications. It is also resorted to as either a prophylactic or curative measure in case of paraesophageal hernia where strangulation can occur. The surgery aims at reducing the size of the opening in your diaphragm, or reconstructing the esophageal sphincter, or removing the hernia sac. This can be done either by opening up the chest (thoracotomy) or abdomen (laparotomy), or by laparoscopy (inserting a very small camera and tiny surgical tools through small incisions in the abdomen). Advantages of laparoscopy are fewer complications and quicker recovery time.
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