A weakness in the diaphragm that allows stomach contents to wash upward into the gullet.

Causes of Hiatus Hernia

This extremely common condition follows from the inevitable weakening of the diaphragm as people get older.

The diaphragm stretches across the upper abdomen, roughly in line with the lower ribs. It is a sheet of tough muscular fibres, which marks the boundary between the chest and the abdominal contents. One important function of the diaphragm is in breathing: as the diaphragm moves up and down it draws air into the lungs.

Certain structures have to pass from the chest into the abdomen, notably major blood vessels, nerves and the gullet. The junction between the gullet and the stomach is especially important since without a tight seal, the contents of the stomach will wash up into the gullet, the walls of which are not designed to withstand the powerful stomach acid.

A hiatus hernia alone does not necessarily lead to symptoms unless other factors increase the chances of acid washing back up, known as reflux. These include obesity, smoking and high alcohol intake.

Symptoms of Hiatus Hernia

Acid in the lower gullet produces heartburn with belching and pain localized behind the breastbone. It is typical that the symptoms are worse when you are lying flat or bending over, circumstances in which the stomach contents can more easily reflux. Having a hiatus hernia does not inevitably mean that you will get symptoms; nor is it necessary to have a hiatus hernia to get symptoms from reflux, although having one does make reflux for any other reason worse.

A hiatus hernia is diagnosed on a barium swallow, which shows a characteristic appearance. The constant irritation of the gullet can lead to inflammation and oozing of blood which can, in turn, lead to anaemia. Endoscopy is necessary to establish how inflamed the lower gullet is and to look for complications such as ulceration or constriction.

Treatment of Hiatus Hernia

This can be as straightforward as avoiding wearing tight clothes around the waist, reducing smoking and raising the head of the bed slightly, all of which reduce the chances of acid refluxing through the hiatus hernia. Otherwise treatment is similar to that for indigestion or heartburn. Initially there are antacids, especially those containing alginate, which form an insulating layer on the acid, reducing the chances of reflux. Next steps include acid-reducing drugs such as H2 blockers (cimetidine and ranitidine) and proton pump inhibitors (lansoprazole and omeprazole). Other drugs increase the rate at which food passes through the stomach, again reducing the chances of reflux; these include cisapride and metoclopramide.

Surgery

It is possible to repair the weakness of the diaphragm and restore the normal anatomy. This is not surgery to be lightly undertaken without tests to make quite sure that the hiatus hernia is the cause of the symptoms and that all medical avenues have been explored. The repair can now be done laparoscopically (keyhole surgery), avoiding the previous extensive surgery that required opening both the chest and the abdomen.

QUESTIONS

How important is reflux?

Symptomatically reflux is greatly annoying by interfering with the enjoyment of food. Constant irritation can lead to narrowing of the gullet and difficulty in swallowing. This has been shown to be more common than once thought, stimulating research into improving diagnosis and treatment.

Are there other risks?

Constant irritation of the gullet by acid may predispose the cells to become cancerous. A great deal of research is currently addressing the problem as to which people should have endoscopy to detect these changes and how often.

Complementary Treatment

In cymatics corrective soundwaves will be focused on your abdomen, thus rebalancing its energy to promote healing. Alexander Technique – hernias can be helped by improved postural balance and a decrease in contractions along the spinal column. Reflexology treatment is aimed at reflex points associated with the adrenal glands and the affected area. You will find that a nutritional therapist or a naturopath could tailor a diet to help you reduce acidity. Other therapies to try: homoeopathy; Chinese herbalism.