HIATAL HERNIA also called a diaphragmatic hernia. is a condition where there is a defect in your diaphragm.

m. The defect affects the hiatus (small opening) in the diaphragm, which the esophagus (food pipe) passes through on its way to the stomach. The defect allows the stomach to pass through the hiatus and bulge upward into the chest. The diaphragm is a muscular wall that separates your chest and abdomen (stomach). With a hiatal hernia, the hiatus in the diaphragm is too large or the muscles around the hiatus are weak. A large opening may allow a part of the stomach to go up into the chest. As the herniated part moves up and down or gets trapped in the chest, it causes acid reflux. This means that the food and acid in the stomach back up into the esophagus. This irritates and damages the esophagus, and may cause a burning feeling in the chest called heartburn. Hiatal hernia is a condition in which part of the stomach sticks upward into the chest, through an opening in the diaphragm. Hiatal hernia is a common condition. By age 60, up to 60% of people have it to some degree. A hernia happens when a portion of fatty tissue or organ pushes through the muscular wall that usually contains it.

stomach (the fundus) bulges up into the chest cavity. This type of hernia normally remains in one place, sitting next to the oesophagus, and does not move in or out when you swallow. CAUSES Suspected causes or contributing factors Obesity Poor seated posture (such as slouching) Frequent coughing Straining with constipation Frequent bending over or heavy lifting Heredity Smoking Congenital defects Hiatal hernias are very common, especially in people over 50 years old. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus.

SIGNS AND SYMTOMS TYPES OF HIATAL HERNIA Sliding hiatus hernias Most common type (90%) 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 stomach protrude up through the oesophageal opening in the diaphragm into the chest cavity. The herniated portion of the stomach can slide back and forth, into and out of the chest. Paraesophageal Rolling hiatus hernia this is sometimes called a paraoesophageal hiatus hernia by doctors. In this case, part of the stomach bulges into the chest out of the weakest part of the diaphragm, which is the oesophageal opening. The junction of the oesophagus and stomach stays down within the abdomen, and the top part of the

Chest pain Heartburn, worse when bending over or lying down Swallowing difficulty

A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are usually due to the reflux of gastric acid, air, or bile.

DIAGNOSTIC TEST

Barium swallow: This test is an x-ray of your throat and esophagus, the tube connecting your throat to your stomach. This test may also be called a barium esophagram. You will drink a thick liquid called barium. Barium helps your esophagus and stomach show up better on x-rays. Follow the instructions of your caregiver before and after the test. Endoscopy: This test uses a scope to see the inside of your digestive tract. A scope is a

long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests. Small tumors may be removed, and bleeding may be treated during an endoscopy.

Treatment The goals of treatment are to relieve symptoms and prevent complications. Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) will relieve pain. Medications that neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esphagus) may be prescribed. Other measures to reduce symptoms include:

Esophageal manometry: This test measures the pressure within the esophagus and stomach. Esophageal pH monitoring: A small probe is placed inside the esophagus and stomach to check the pH of your stomach acid. The pH measures how much acid is in your stomach. This test also measures the amount of acid that goes into the esophagus. Upper GI x-rays: During an upper GI series, an x-ray machine is used to take pictures of your stomach and intestines (bowel). You may be given a chalky liquid to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the x-rays. An upper GI series can show if you have an ulcer, a blocked intestine, or other problems.

Avoiding large or heavy meals Not lying down or bending over right after a meal Reducing weight and not smoking

Outlook (Prognosis) Treatment can relieve most symptoms of hiatal hernia. Possible Complications

MEDICATION Antacids Histamine receptor antagonist control reflux

Pulmonary (lung) aspiration Slow bleeding and iron deficiency anemia (due to a large hernia) Strangulation (closing off) of the hernia

If these measures do not control the symptoms, or you have complications, you may need surgery to repair the hernia.

Medications for heartburn If you experience heartburn and acid reflux, your doctor may recommend medications, such as: DIET

Antacids that neutralize stomach acid. Overthe-counter antacids, such as Gelusil, Maalox, Mylanta, Rolaids and Tums, may provide quick relief. Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75). Stronger versions of these medications are available in prescription form. Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-thecounter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Stronger versions of these medications are available in prescription form.

Avoid eating in the late evening and avoid foods are highly acidic Hiatal Hernia: Foods to Avoid The following foods are highly acidic and/or may weaken the lower esophageal sphincter, making it easier for stomach acids to back up into your esophagus:

Citrus foods, such as oranges, grapefruits, and lemons, and orange juice, grapefruit juice, cranberry juice, and lemonade Chocolate Fatty and fried foods, such as fried chicken and fatty cuts of meat Garlic and onions

Spicy food Peppermint and spearmint Tomato-based foods such as spaghetti sauce, pizza, chili, salsa, and tomato juice Coffee, tea (including decaffeinated versions), and alcohol Carbonated beverages Dairy products, such as whole milk, ice cream, and creamed food. Try soy milk; it may be a good milk substitute. Also, mild cheeses, like feta or goat, may be enjoyed in moderation, or more often if you can tolerate them. Oil and butter

Hiatal Hernia: Foods to Enjoy The following foods are low-acid-producing foods and should not aggravate your hiatal hernia symptoms:

Bananas and apples Green beans, peas, carrots, and broccoli Grains, like cereals (bran and oatmeal), bread, rice, pasta, and crackers Low-fat or skim milk and low-fat yogurt Egg whites and egg substitutes Fat-free cheeses, cream cheese, and fat-free sour cream Lean meat, chicken, and fish Water Pretzels, graham crackers, rice cakes, and baked potato chips Low-fat sweets (no chocolate or mint)

SURGERY