You have probably heard people comment on their “hernias.” You may even have a hernia yourself and not know it.
A hiatal hernia is a protrusion of a portion of the stomach from its normal position in the abdomen through the diaphragm, which is the bell-shaped sheet of muscle that separates the abdomen from the lungs and aids in breathing. Hiatal hernias may result from birth defects or injuries.
More than 40 percent of people have what’s called a “sliding hiatal hernia” Sliding hiatal hernias are common among smokers, overweight persons, and older women. They can occur as a result of activities or conditions that put pressure on the abdomen, such as persistent coughing and sudden physical exertion.
Sliding hiatal hernias may not produce symptoms or they may cause heartburn, especially when you lean forward, strain, or lie down.
Another type of hernia is a paraesophageal hiatal hernia. In this form, the junction between the esophagus and stomach is in the normal place below the diaphragm, but a portion of the stomach is pushed above the diaphragm and lies beside the esophagus.
Hernias may get trapped or pinched by the diaphragm and lose their blood supply. Such trapping is a serious and painful condition, called strangulation that requires immediate surgery.
Symptoms of strangulated hiatal hernia include sudden severe chest pain and difficulty swallowing. Rarely, bleeding from the lining of the hernia may occur with either type.
Immediate medical attention is required.
Your doctor may suspect that you have a hiatal hernia based on symptoms. To confirm the diagnosis, the doctor may order.
- A chest X-ray
- Esophagoscopy, in which a viewing tube is inserted down the throat
- Barium swallow, an X-ray in which you swallow a fluid that reveals abnormalities on the X-ray
- Manometry, a test that uses pressure measurements to diagnose abnormal movements inside the esophagus
- Electrocardiogram (ECG or EKG), to make sure your pain is not related to a heart condition
A hiatal hernia may not cause symptoms or may slowly worsen over time. Most do not require treatment, however, you may be encouraged to follow diet-based lifestyle changes. Fewer than five percent of patients require surgery.
You should call your doctor if you suffer from persistent heartburn, or have trouble swallowing or taking a breath after a meal. Get help immediately if you develop heartburn that is associated with nausea, vomiting, shortness of breath, heart palpitations, dizziness, or irregular heartbeats. These could be signs of a more serious heart of digestive problem.
SOURCE: InteliHealth, Health A to Z and The Merck Manual of Medical Information, Home Edition, 1997.
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