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___________________________________________________________________________
Hiatal Hernia Causes, Symptoms, Diagnosis, and Treatment Produced by Medical Doctors on MedicineNet.com
What is a hiatal hernia?
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.
Normally, the esophagus or food tube passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.
My Symptoms Of Hiatal HerniaProlonged heartburn and(24 hours and longer) use of antacids until my body became immune to them. Shortness of breath, burping, gas build up...Medical Symptoms Description
The vast majority of hiatal hernias are of the sliding type, and most of them are not associated with symptoms. The larger the hernia, the more likely it is to cause symptoms. When sliding hiatal hernias produce symptoms, they almost always are those of gastroesophageal reflux disease (GERD) or its complications. This occurs because the formation of the hernia often interferes with the barrier (lower esophageal sphincter) which prevents acid from refluxing from the stomach into the esophagus. Additionally, it is known that patients with GERD are much more likely to have a hiatal hernia than individuals not afflicted by GERD. Thus, it is clear that hiatal hernias contribute to GERD. However, it is not clear if hiatal hernias alone can result in GERD. Since GERD may occur in the absence of a hiatal hernia, factors other than the presence of a hernia can cause GERD.
Best Treatment of A Hiatal Hernia
Diaphragm Shifting Technique- My Video Teaches You How To Do It At www.hiatusherniarelief.com. You can do it at home, and you can do within 3 minutes time.
Are there different types of hiatal hernias?
Hiatal hernias are categorized as being either sliding or para-esophageal.
Sliding hiatal hernias
Sliding hiatal hernias, the most common type of hernia, are those in which the junction of the esophagus and stomach, referred to as the gastro-esophageal junction, and part of the stomach protrude into the chest. The junction may reside permanently in the chest, but often it juts into the chest only during a swallow. This occurs because with each swallow the muscle of the esophagus contracts causing the esophagus to shorten and to pull up the stomach. When the swallow is finished, the herniated part of the stomach falls back into the abdomen. Para-esophageal hernias are hernias in which the gastro-esophageal junction stays where it belongs (attached at the level of the diaphragm), but part of the stomach passes or bulges into the chest beside the esophagus. The para- esophageal hernias themselves remain in the chest at all times and are not affected by swallows.
Para-esophageal hiatal hernias
A para-esophageal hiatal hernia that is large, particularly if it compresses the adjacent esophagus, may impede the passage of food into the stomach and cause food to stick in the esophagus after it is swallowed. Ulcers also may form in the herniated stomach due to the trauma caused by food that is stuck or acid from the stomach. Fortunately, large para-esophageal hernias are uncommon.
Causes Of A Hiatal Hernia-
It is thought that hiatal hernias are caused by a larger-than-normal esophageal hiatus, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen; as a result of the large opening, part of the stomach "slips" into the chest. Other potentially contributing factors include:
- A permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid) which pulls the stomach up.
- An abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.
Hiatal Hernia Picture
How does a hiatal hernia cause GERD?
Normally, there are several mechanisms to prevent acid from flowing backwards (refluxing) up into the esophagus. One mechanism involves a band of esophageal muscle where the esophagus joins the stomach called the lower esophageal sphincter that remains contracted most of the time to prevent acid from refluxing or regurgitating. The sphincter only relaxes when food is swallowed, allowing food to pass from the esophagus and into the stomach. The sphincter normally is attached firmly to the diaphragm in the hiatus, and the muscle of the diaphragm wraps around the sphincter. The muscle that wraps around the sphincter augments the pressure of the contracted sphincter to further prevent reflux of acid.
Another mechanism that prevents reflux is the valve-like tissue at the junction of the esophagus and stomach just below the sphincter. The esophagus normally enters the stomach tangentially so that there is a sharp angle between the esophagus and stomach. The thin piece of tissue in this angle, composed of esophageal and stomach wall, forms a valve that can close off the opening to the esophagus when pressure increases in the stomach, for example, during strenuous exercise.
When a hiatal hernia is present, two changes occur. First, the sphincter slides up into the chest while the diaphragm remains in its normal location. As a result, the pressure normally generated by the diaphragm overlying the sphincter and the pressure generated by the sphincter no longer overlap, and as a result, the total pressure at the gastro-esophageal junction decreases. Second, when the gastro-esophageal junction and stomach are pulled up into the chest with each swallow, the sharp angle where the esophagus joins the stomach becomes less sharp and the valve-like effect is lost. Both changes promote reflux of acid.
The only way to get the gastro-esophageal junction and stomach are pulled back down into the stomach is by doing the diapragm shifting technique.
How is a hiatal hernia diagnosed?
Hiatal hernias are diagnosed incidentally when an upper gastrointestinal x-ray or endoscopy is done during testing to determine the cause of upper gastrointestinal symptoms such as upper abdominal pain. On both the x-ray and endoscopy, the hiatal hernia appears as a separate "sac" lying between what is clearly the esophagus and what is clearly the stomach. This sac is delineated by the lower esophageal sphincter above and the diaphragm below. The hernia may only be visible during swallows, however.
How is a hiatal hernia treated?
Treatment of large para-esophageal hernias causing symptoms requires surgery or another natural technique called the diaphragm shifting technique. During surgery or the natural free technique, the stomach is pulled down into the abdomen, the esophageal hiatus is made smaller, and the esophagus is attached firmly to the diaphragm. During the natural technique the stomach is pulled down with body weight and tucked secure underneath the sphincter reseting the diaphragm. These procedure restores the normal anatomy.
Since sliding hiatal hernias rarely cause problems themselves but rather contribute to acid reflux, the treatment for patients with hiatal hernias is usually the same as for the associated GERD. If the GERD is severe, complicated, or unresponsive to reasonable doses of medications, surgery often is performed. At the time of surgery, the hiatal hernia is eliminated in a manner similar to the repair of para-esophageal hernias. However, in addition, part of the upper stomach is wrapped around the lower sphincter to augment the pressure at the sphincter and further prevent acid reflux.
Hiatal Hernia At A Glance
- A hiatal hernia is an anatomical abnormality of the esophagus.
- Hiatal hernias contribute to gastro-esophageal reflux disease (GERD).
- The symptoms in individuals with hiatal hernias parallel the symptoms of the associated GERD.
- The treatment of most hiatal hernias is the same as for the associated GERD.
Pathophysiology
The esophagus passes through the diaphragmatic hiatus in the crural part of the diaphragm to reach the stomach. The diaphragmatic hiatus itself is approximately 2 cm in length and chiefly consists of musculotendinous slips of the right and left diaphragmatic crura arising from either side of the spine and passing around the esophagus before inserting into the central tendon of the diaphragm. The size of the hiatus is not fixed, but narrows whenever intra-abdominal pressure rises, such as when lifting weights or coughing.
The lower esophageal sphincter (LES) is an area of smooth muscle approximately 2.5-4.5 cm in length. The upper part of the sphincter normally lies within the diaphragmatic hiatus, while the lower section normally is intra-abdominal. At this level, the visceral peritoneum and the phrenoesophageal ligament cover the esophagus. The phrenoesophageal ligament is a fibrous layer of connective tissue arising from the crura, and it maintains the LES within the abdominal cavity. The A-ring is an indentation sometimes seen on barium studies, and it marks the upper part of the LES. Just below this is a slightly dilated part of the esophagus, forming the vestibule. A second ring, the B-ring, may be seen just distal to the vestibule, and it approximates the Z-line or squamocolumnar junction. The presence of a B-ring confirms the diagnosis of a hiatal hernia. Occasionally, the B-ring also is called the Schatzki ring.
Any sudden increase in intra-abdominal pressure also acts on the portion of the LES below the diaphragm to increase the sphincter pressure. An acute angle, the angle of His, is formed between the cardia of the stomach and the distal esophagus and functions as a flap at the gastroesophageal junction and helps prevent reflux of gastric contents into the esophagus (see Media file 1). The gastroesophageal junction acts as a barrier to prevent reflux of contents from the stomach into the esophagus by a combination of mechanisms forming the antireflux barrier. The components of this barrier include the diaphragmatic crura, the LES baseline pressure and intra-abdominal segment, and the angle of His.
Frequency
United States
Hiatal hernias are more common in Western countries. The frequency of hiatus hernia increases with age, from 10% in patients younger than 40 years to 70% in patients older than 70 years.
International
Burkitt et al suggest that the Western, fiber-depleted diet leads to a state of chronic constipation and straining during bowel movement, which could explain the higher incidence of this condition in Western countries.
Mortality/Morbidity
Paraesophageal hernias generally tend to enlarge with time, and sometimes the entire stomach is found within the chest. The risk of these hernias becoming incarcerated, leading to strangulation or perforation, is approximately 5%. This complication is potentially lethal, and surgical intervention is necessary. Because of the high mortality associated with this condition, elective repair often is advised wherever a paraesophageal hernia is found.
Sex
Hiatal hernias are more common in women than in men. This might relate to the intra-abdominal forces exerted in pregnancy.
Age
Muscle weakening and loss of elasticity as people age is thought to predispose to hiatus hernia, based on the increasing prevalence in older people. With decreasing tissue elasticity, the gastric cardia may not return to its normal position below the diaphragmatic hiatus following a normal swallow. Loss of muscle tone around the diaphragmatic opening also may make it more patulous.
Clinical
History
Hiatal hernias are relatively common and, in themselves, do not cause symptoms. For this reason, most people with hiatal hernias are asymptomatic. Hiatal hernias may predispose to reflux or worsen existing reflux in a minority of individuals. Physicians should resist the temptation to label hiatal hernia as a disease.
Patients can have reflux without a demonstrable hiatal hernia. When a hernia is present in a patient with symptomatic GERD, the hernia may worsen symptoms for several reasons, including the hiatal hernia acting as a fluid trap for gastric reflux and increasing the acid contact time in the esophagus. In addition, with a hiatal hernia, episodes of transient relaxation of the LES are more frequent and the length of the high-pressure zone is reduced. The main symptoms of a sliding hiatal hernia are those associated with reflux and its complications.
No clear correlation exists between the size of a hiatal hernia and the severity of the symptoms. A very large hiatal hernia may be present with no symptoms at all. Some complications are specific for a hiatal hernia.
- Esophageal complications
- By far, the majority of hiatal hernias are asymptomatic.
- Often, patients are left with the impression that they have a disease when a hiatal hernia is diagnosed.
- In rare cases, however, a hiatal hernia may be responsible for intermittent bleeding from associated esophagitis, erosions (Cameron ulcers), or a discrete esophageal ulcer, leading to iron-deficiency anemia. The prevalence of large hiatal hernias in patients with iron deficiency anemia is 6-7%. This particular complication is more likely in patients who are bed-bound or those who take nonsteroidal anti-inflammatory drugs. Massive bleeding is rare.
- Nonesophageal complications
- Incarceration of a hiatal hernia is rare and is observed only with paraesophageal hernia.
- When this occurs, it can present abruptly, with a sudden onset of vomiting and pain, sometimes requiring immediate operative intervention.
Physical
The physical examination usually is unhelpful. Certain conditions predispose to the development of hiatus hernia. These include obesity, pregnancy, and ascites.
Diet - An appropriate diet maintains an ideal body mass index. Obesity predisposes to reflux disease.
- Weekly Or Bi-Weekly Use Of Diaphragm Shifting Technique.
- Burkitt et al suggest that the Western, fiber-depleted diet leads to a state of chronic constipation and straining during bowel movement, which would explain the higher incidence of this condition in Western countries.
Medication
Medication Typically Just Masks the problem long term, some doctors would recommend the following...
"Symptomatic acid reflux can be treated medically, either by neutralizing acid with antacids or blocking acid secretion with H2-receptor blocking drugs or the more potent PPIs. The treatment of GERD is discussed in Gastroesophageal Reflux Disease. Hiatal hernias, per se, only require attention if they are causing symptoms because of their size or if the patient is at risk of strangulation, in which case surgery may be indicated."
But the bottom line is this may help temporarily, but to get rid of the root problem (a small stomach above your stomach) you need to shift it back below your diaphragm by using the diaphragm shiting technique.
Hiatal Hernia Surgical Care
If you have to go this route you have to, but at least the diaphragm shifting technique a try first.
A patient with a large hiatal hernia may experience vague intermittent chest discomfort or pain. The paraesophageal hernia may strangulate and frequently is operated on prophylactically to prevent this complication. Paraesophageal hernias may present in infants or adults as a potentially life-threatening complication of strangulation, and prompt surgical repair is key. When found in asymptomatic individuals, laparoscopic repair is often undertaken, with large defects in the diaphragm being closed with mesh.
Surgery is necessary only in the minority of patients with complications of GERD despite aggressive treatment with proton pump inhibitors (PPIs). Because only a minority of patients with hiatal hernia have any problems, this represents a very small proportion of patients with sliding hiatal hernia; most patients with problems are managed medically.
By far, the majority of patients who would have undergone surgery in the past are managed successfully today with PPIs. However, young patients with severe or recurrent complications of GERD, such as strictures, ulcers, and bleeding, who cannot afford lifelong PPI treatment or would prefer to avoid taking medications long term, may be surgical candidates.
Another group of patients who are surgical candidates are those with pulmonary complications, in particular, asthma, recurrent aspiration pneumonia, chronic cough, or hoarseness linked to reflux disease.
Three major types of surgical procedures correct gastroesophageal reflux and repair the hernia in the process. They can be performed by open laparotomy or with laparoscopic approaches, which currently are being employed more frequently.
- Nissen fundoplication
- The Nissen fundoplication performed laparoscopically has gained popularity because of its lower morbidity and shorter hospital stay compared to the open procedure performed previously. Although a relatively high incidence of postoperative complications, such as dysphagia and gas bloating, are reported, DeMeester and Peters have shown that placing a larger bougie in the esophagus during this procedure, along with a shorter wrap and more complete mobilization of the stomach, have markedly reduced postoperative complications.
- This procedure involves a 360° fundic wrap around the gastroesophageal junction. The diaphragmatic hiatus also is repaired.
- A transthoracic approach may be used in patients who have had a previous Nissen wrap or those who have an irreducible hernia.
- The Toupet procedure is a variant of the Nissen wrap and involves a 180° wrap in an attempt to lessen the likelihood of postoperative dysphagia.
- Belsey (Mark IV) fundoplication: This operation involves a 270° wrap in an attempt to reduce the incidence of gas bloating and postoperative dysphagia. It also is preferred when minimal esophageal dysmotility is suspected. To complete this operation, the left and right crura of the diaphragm are approximated.
- Hill repair: In this procedure, the cardia of the stomach is anchored to the posterior abdominal areas, such as the medial arcuate ligament. This also has the effect of augmenting the angle of His and thus strengthening the antireflux mechanism.
- The antireflux procedures discussed above offer relief of symptoms in 80-90% of patients. In most cases, the procedure of choice is the one with which the surgeon is most familiar. These procedures carry low mortality and morbidity rates, lower than 15-20%. DeMeester et al found the Nissen procedure superior to the Belsey and Hill repairs with regard to symptom relief and prevention of reflux postoperatively (as judged by pH monitoring). Good long-term results have been reported for antireflux surgery, with adequate control of reflux in the range of 80% at 10 years.
- Most patients with a paraesophageal hernia remain asymptomatic. In this type of hernia, symptoms from acid reflux usually do not occur. Instead, the most common symptom is epigastric or substernal pain. Some patients complain of substernal fullness, nausea, and dysphagia.
- A significant proportion of patients with this type of hernia develop incarceration of the hernia and possible gastric volvulus, which can lead to perforation.
- If perforation occurs, the mortality rate is high. Because of this, many surgeons advise elective repair when the diagnosis is made.
- The goal of surgery is to remove the hernia sac and close the abnormally wide esophageal hiatus.
- Some surgeons then tack the stomach down in the abdomen to prevent it from migrating upwards again, or, they perform a temporary gastrostomy to help decompress the stomach and anchor it in place in the abdominal cavity.
Patient Education
- Raise awareness of the potential for complications of each type of hernia.
- Complications of the hernia itself: Paraesophageal hernia may strangulate.
- Complications from reflux disease: Heartburn, strictures, Barrett esophagus, and esophageal cancer may occur in a minority of patients with hiatal hernias.
- Instruct patients to seek medical attention if new symptoms develop or if GERD symptoms are poorly controlled.
- For excellent patient education resources, visit eMedicine's Esophagus, Stomach, and Intestine Center. Also, see eMedicine's patient education article Hiatal Hernia.
Miscellaneous
Medicolegal Pitfalls
- Failure to recognize cardiac disease, chronic lung disease, Barrett esophagus, strictures, and asthma
- Failure to distinguish the more common and benign sliding hernia from the paraesophageal type
Google Trends For Hiatal Hernia Sufferers-
US Cities
US Cities
| Cities | ||
| Pittsburgh, PA, USA | ||
| Baltimore, MD, USA | ||
| Louisville, KY, USA | ||
| Philadelphia, PA, USA | ||
| Tampa, FL, USA | ||
| Cincinnati, OH, USA | ||
| Phoenix, AZ, USA | ||
| Newark, NJ, USA | ||
| Reston, VA, USA | ||
Top States
| Subregions | ||
| Alabama, United States | ||
| Tennessee, United States | ||
| Pennsylvania, United States | ||
| Louisiana, United States | ||
| Kentucky, United States | ||
| Oklahoma, United States | ||
| Nebraska, United States | ||
| Maine, United States | ||
| Iowa, United States | ||
Top Cities For Acid Reflux
| Cities | ||
| Raleigh, NC, USA | ||
| Charlotte, NC, USA | ||
| Albany, NY, USA | ||
| Atlanta, GA, USA | ||
| St Louis, MO, USA | ||
| Columbus, OH, USA | ||
| Cincinnati, OH, USA | ||
| Philadelphia, PA, USA | ||
| Houston, TX, USA | ||
Hiata Sufferer Discussions
Comment from: farmerboy, 45-54 Male (Patient)
I have had all the symptoms listed in this discussed thus far. I have a para esophageal hiatal hernia. Your quality of life does not have to suffer. You can get relief. Surgery is definitely the way to go. Get yourself a specialist in hiatal hernia repairs, or you'll be getting the surgery more than once. Don’t settle for just a general surgeon or even just a gastro specialist. Been there, done that and am a 3 time offender. Ask the doctor what their success rate is and even ask to talk to some of their treated patients. (Hint: Ask them how many times they have been fixed for this problem.) It is a long very serious surgery, but I for one want to live my life as normal as possible and this surgery is the way to go if you are a candidate for it. Published: February 05 ::
I have had all the symptoms listed in this discussed thus far. I have a para esophageal hiatal hernia. Your quality of life does not have to suffer. You can get relief. Surgery is definitely the way to go. Get yourself a specialist in hiatal hernia repairs, or you'll be getting the surgery more than once. Don’t settle for just a general surgeon or even just a gastro specialist. Been there, done that and am a 3 time offender. Ask the doctor what their success rate is and even ask to talk to some of their treated patients. (Hint: Ask them how many times they have been fixed for this problem.) It is a long very serious surgery, but I for one want to live my life as normal as possible and this surgery is the way to go if you are a candidate for it. Published: February 05 ::
Comment from: Mendy, 65-74 Female (Patient)
I am 69 years old and was diagnosed with a hiatal hernia many years ago. The only medication that has worked for me is Nexium, 40 mg. Recently, I have been taking the Nexium two times a day and also some antacid over-the-counter pills. On New Year’s Day, I went to the emergency room because I thought that I was having a heart attack. I had eaten a very small amount of scrambled eggs and felt so bloated that I thought I would burst. I began getting a great deal of pressure in my upper abdomen, back, neck, and upper arms. I couldn't stand up straight. I took two antacid pills and continued to feel worse. I finally went to the ER and thankfully my EKG and cardiac enzymes were fine. On X-ray, the doctor saw what he thought was my esophagus being pushed to one side of my chest. Then he did an MRI and said that it was a GI problem, gave me a GI cocktail, and I immediately felt better. I can't get an appointment with a GI doctor until April. Published: January 14 ::
I am 69 years old and was diagnosed with a hiatal hernia many years ago. The only medication that has worked for me is Nexium, 40 mg. Recently, I have been taking the Nexium two times a day and also some antacid over-the-counter pills. On New Year’s Day, I went to the emergency room because I thought that I was having a heart attack. I had eaten a very small amount of scrambled eggs and felt so bloated that I thought I would burst. I began getting a great deal of pressure in my upper abdomen, back, neck, and upper arms. I couldn't stand up straight. I took two antacid pills and continued to feel worse. I finally went to the ER and thankfully my EKG and cardiac enzymes were fine. On X-ray, the doctor saw what he thought was my esophagus being pushed to one side of my chest. Then he did an MRI and said that it was a GI problem, gave me a GI cocktail, and I immediately felt better. I can't get an appointment with a GI doctor until April. Published: January 14 ::
Comment from: esined 56, 45-54 Female (Patient)
I have been diagnosed with a hiatal hernia. I recently gained a few pounds, and that’s when it got worse. I had to change my diet. No citrus, chocolate, caffeine, tomato or spicy foods. Some over-the-counter medications have caffeine in them, such as Excedrin. So I cut out some of these products and I felt better. Oh, and I do not eat or drink three hours before going to bed. I use extra pillows when sleeping. Published: January 14 ::
I have been diagnosed with a hiatal hernia. I recently gained a few pounds, and that’s when it got worse. I had to change my diet. No citrus, chocolate, caffeine, tomato or spicy foods. Some over-the-counter medications have caffeine in them, such as Excedrin. So I cut out some of these products and I felt better. Oh, and I do not eat or drink three hours before going to bed. I use extra pillows when sleeping. Published: January 14 ::
Comment from: Miserable, 25-34 Male (Patient)
Since I was about 20, I've had a strange feeling in my lower chest, mostly on the left side. For a long time, I thought there was something wrong with my heart, but there was really never any direct evidence, and it began to be more of a pressure and a constant discomfort under my ribs. No doctor could tell me anything other than "you're fine," and so the mystery continued. Only now at age 29 have I finally gotten an endoscopy. I apparently have a "small" hiatal hernia and "mild" gastritis. All I want is to feel a normal feeling in my body and not bloated, gassy, and on the verge of a heart attack all the time. It just seems as of it’s something easy enough to fix but my doctor says there are no good surgeons in Las Vegas who can do the operation. My journey starts here, and hopefully this helps somebody else figure it out. Published: December 16 ::
Since I was about 20, I've had a strange feeling in my lower chest, mostly on the left side. For a long time, I thought there was something wrong with my heart, but there was really never any direct evidence, and it began to be more of a pressure and a constant discomfort under my ribs. No doctor could tell me anything other than "you're fine," and so the mystery continued. Only now at age 29 have I finally gotten an endoscopy. I apparently have a "small" hiatal hernia and "mild" gastritis. All I want is to feel a normal feeling in my body and not bloated, gassy, and on the verge of a heart attack all the time. It just seems as of it’s something easy enough to fix but my doctor says there are no good surgeons in Las Vegas who can do the operation. My journey starts here, and hopefully this helps somebody else figure it out. Published: December 16 ::
Comment from: Emily, 13-18 Female
I am 15 years old, and I have a hiatal hernia. A few months ago, I had a foreign object lodged in my esophagus and needed an endoscopy. After the procedure, my doctor told me that I had the hernia, and I might have gotten it from the scope accidently poking a hole through my diaphragm, but it might have been there already. Lately, I have been extremely nauseous and whenever I lie down, I feel acid come up from my esophagus, resulting in extreme nausea and burning. I can barely eat anymore because of the acid indigestion. I plan on going to the doctor soon to see if there's a medication to help. Published: January 14 ::
I am 15 years old, and I have a hiatal hernia. A few months ago, I had a foreign object lodged in my esophagus and needed an endoscopy. After the procedure, my doctor told me that I had the hernia, and I might have gotten it from the scope accidently poking a hole through my diaphragm, but it might have been there already. Lately, I have been extremely nauseous and whenever I lie down, I feel acid come up from my esophagus, resulting in extreme nausea and burning. I can barely eat anymore because of the acid indigestion. I plan on going to the doctor soon to see if there's a medication to help. Published: January 14 ::
Comment from: Mike, 25-34 Male (Patient)
I am 25. I was diagnosed with hiatal hernia after an endoscopy five months ago. Sometimes, I feel this sharp pain on my abdomen. I do not vomit, I don’t have nausea or heartburn, but I often feel this pain in my central abdomen below my ribs. Published: January 14 ::
I am 25. I was diagnosed with hiatal hernia after an endoscopy five months ago. Sometimes, I feel this sharp pain on my abdomen. I do not vomit, I don’t have nausea or heartburn, but I often feel this pain in my central abdomen below my ribs. Published: January 14 ::
Comment from: Fed Up in England, 45-54 Female (Patient)
As of today, I have tried many PPIs to no avail. It is worse, as I suffer from reflux badly, 24 hours a day. I also have hiatal hernia that was only found a couple of months ago after several endoscopies. I am 49 years old and I have been suffering for more than 12 years now. My twin sister also suffers the same as me, but she is worse. Published: January 14 ::
Comment from: Herniasucks, 25-34 Female (Patient) I am 27, and I was told that I have hiatal hernia. I was prescribed Protonix; however, I started getting an allergic reaction to it. I started getting itchiness and rashes after taking Protonix for about a month. I guess I have to go back to the drawing board. Published: December 16 :: As of today, I have tried many PPIs to no avail. It is worse, as I suffer from reflux badly, 24 hours a day. I also have hiatal hernia that was only found a couple of months ago after several endoscopies. I am 49 years old and I have been suffering for more than 12 years now. My twin sister also suffers the same as me, but she is worse. Published: January 14 ::
Gerd
Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD)
What is GERD?
Gastroesophageal reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called acid reflux or acid regurgitation, because digestive juices—called acids—rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.
When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.
What are the symptoms of GERD?
The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.
What causes GERD?
The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms.
Other factors that may contribute to GERD include
- obesity
- pregnancy
- smoking
Common foods that can worsen reflux symptoms include
- citrus fruits
- chocolate
- drinks with caffeine or alcohol
- fatty and fried foods
- garlic and onions
- mint flavorings
- spicy foods
- tomato-based foods, like spaghetti sauce, salsa, chili, and pizza
What is GERD in children?
Distinguishing between normal, physiologic reflux and GERD in children is important. Most infants with GER are happy and healthy even if they frequently spit up or vomit, and babies usually outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD. Studies show GERD is common and may be overlooked in infants and children. For example, GERD can present as repeated regurgitation, nausea, heartburn, coughing, laryngitis, or respiratory problems like wheezing, asthma, or pneumonia. Infants and young children may demonstrate irritability or arching of the back, often during or immediately after feedings. Infants with GERD may refuse to feed and experience poor growth.
Talk with your child’s health care provider if reflux-related symptoms occur regularly and cause your child discomfort. Your health care provider may recommend simple strategies for avoiding reflux, such as burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, your health care provider may recommend that your child eat small, frequent meals and avoid the following foods:
- sodas that contain caffeine
- chocolate
- peppermint
- spicy foods
- acidic foods like oranges, tomatoes, and pizza
- fried and fatty foods
Avoiding food 2 to 3 hours before bed may also help. Your health care provider may recommend raising the head of your child’s bed with wood blocks secured under the bedposts. Just using extra pillows will not help. If these changes do not work, your health care provider may prescribe medicine for your child. In rare cases, a child may need surgery. For information about GER in infants, children, and adolescents, see the Gastroesophageal Reflux in Infants and Gastroesophageal Reflux in Children and Adolescents fact sheets from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
How is GERD treated?
See your health care provider if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, diaphragm shifting technique, medications, or surgery.
Lifestyle Changes
- If you smoke, stop.
- Avoid foods and beverages that worsen symptoms.
- Lose weight if needed.
- Eat small, frequent meals.
- Wear loose-fitting clothes.
- Avoid lying down for 3 hours after a meal.
- Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.
Medications
Your health care provider may recommend over-the-counter antacids or medications that stop acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication.
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Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.
Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.
Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.
Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety, and problems with physical movement.
Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your health care provider is the best source of information about how to use medications for GERD.
What if GERD symptoms persist?
If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.
- Barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x rays are taken. The test will not detect mild irritation, although strictures—narrowing of the esophagus—and ulcers can be observed.
- Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor’s office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found. - pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary—recording when, what, and amounts the person eats—which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.
A completely accurate diagnostic test for GERD does not exist, and tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the lining.
Hiatal Hernia & Acid Reflux Surgery
Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.
DO NOT FORGET TO TRY DIAPHRAGM SHIFTING TECHNIQUE FIRST
Fundoplication is the standard surgical treatment for GERD. Usually a specific type of this procedure, called Nissen fundoplication, is performed. During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.
The Nissen fundoplication may be performed using a laparoscope, an instrument that is inserted through tiny incisions in the abdomen. The doctor then uses small instruments that hold a camera to look at the abdomen and pelvis. When performed by experienced surgeons, laparoscopic fundoplication is safe and effective in people of all ages, including infants. The procedure is reported to have the same results as the standard fundoplication, and people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.
Endoscopic techniques used to treat chronic heartburn include the Bard EndoCinch system, NDO Plicator, and the Stretta system. These techniques require the use of an endoscope to perform the anti-reflux operation. The EndoCinch and NDO Plicator systems involve putting stitches in the LES to create pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny burns on the LES. When the burns heal, the scar tissue helps toughen the muscle. The longterm effects of these three procedures are unknown.
What are the long-term complications of GERD?
Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures—narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Persons with GERD and its complications should be monitored closely by a physician.
Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.
For information about Barrett’s esophagus, see the Barrett’s Esophagus fact sheet from the NIDDK.
Points to Remember
- Frequent heartburn, also called acid indigestion, is the most common symptom of GERD in adults. Anyone experiencing heartburn twice a week or more may have GERD.
- You can have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.
- If you have been using antacids for more than 2 weeks, it is time to see your health care provider. Most doctors can treat GERD. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines.
- Health care providers usually recommend lifestyle and dietary changes to relieve symptoms of GERD. Many people with GERD also need medication. Surgery may be considered as a treatment option.
- Most infants with GER are healthy even though they may frequently spit up or vomit. Most infants outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD.
- The persistence of GER along with other symptoms—arching and irritability in infants, or abdominal and chest pain in older children—is GERD. GERD is the outcome of frequent and persistent GER in infants and children and may cause repeated vomiting, coughing, and respiratory problems.
Hope through Research
The reasons certain people develop GERD and others do not remain unknown. Several factors may be involved, and research is under way to explore risk factors for developing GERD and the role of GERD in other conditions such as asthma and laryngitis.
The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
For More Information
American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet: www.acg.gi.org
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet: www.acg.gi.org
American Gastroenterological Association
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email: member@gastro.org
Internet: www.gastro.org
National Office
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email: member@gastro.org
Internet: www.gastro.org
International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.aboutgerd.org
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.aboutgerd.org
North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
P.O. Box 6
Flourtown, PA 19031
Phone: 215–233–0808
Fax: 215–233–3918
Email: naspghan@naspghan.org
Internet: www.naspghan.org
P.O. Box 6
Flourtown, PA 19031
Phone: 215–233–0808
Fax: 215–233–3918
Email: naspghan@naspghan.org
Internet: www.naspghan.org
Pediatric/Adolescent Gastroesophageal Reflux Association, Inc.
P.O. Box 486
Buckeystown, MD 21717–0486
Phone: 301–601–9541
Email: gergroup@aol.com
Internet: www.reflux.org
P.O. Box 486
Buckeystown, MD 21717–0486
Phone: 301–601–9541
Email: gergroup@aol.com
Internet: www.reflux.org
The National Digestive Diseases Information Clearinghouse collects resource information about digestive diseases for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources. The NIDDK Reference Collection is a service of the National Institutes of Health.
You may view the results of the automatic search on heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD).
If you wish to perform your own search of the database, you may access and search the NIDDK Reference Collection database online.
Diaphragm Water Shifting Technique Also known as (DST) can be found at www.hiatusherniarelief.com.
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