Gastroesophageal reflux disorder (GERD), also known as acid reflux, is an extremely common condition affecting at least 20 percent of people in the United States.* However, not so common is the ability to pinpoint an individual’s cause for acid reflux. At Alexandria Bariatric Surgery, our board-certified surgeon, Dr. James Parrish, is highly experienced in diagnosing patients with GERD—including those with a hiatal hernia, which is a common cause of the condition. Read on below to learn more about the causes and symptoms of hiatal hernias, as well as corrective procedures that may provide life-changing results.
To begin, it’s important to note the internal structure of the mid-body, which begins from the esophagus (food pipe) to the hiatus (opening to the diaphragm), to the diaphragm (the muscle that helps you breathe), and finally to the stomach (the organ that breaks down food and liquids to pass through the body). When a hiatal hernia occurs, that means the upper part of the stomach is being pushed up through the diaphragm and into the chest region, which may cause stomach acid to leak into the esophagus (acid reflux). With that said, it is possible to have a hiatal hernia without acid reflux.
Causes of Hiatal Hernia
There are several ways a hiatal hernia can develop and, therefore, allow the stomach to migrate to a position above the diaphragm, including:
- Heavy and/or repetitive pressure on the muscles around the stomach from coughing, vomiting, straining during bowel movements, and lifting heavy objects
- Weakened muscle tissue from injury or other damage
- Stress over time from aging, smoking, and obesity
In some cases, the exact cause of a hiatal hernia may be unknown, but rest assured this shouldn’t prevent developing an appropriate treatment plan to alleviate discomfort.
Symptoms of Hiatal Hernia
As mentioned above, symptoms don’t always occur from this type of hernia. For individuals who do experience hiatal hernia symptoms, these most often present as:
- Acid reflux or GERD
- Belching
- Nausea
- Vomiting
- Difficulty swallowing
- Regurgitation
- Heartburn
In more severe cases, more frequently associated with a paraesophageal hiatal hernia (as opposed to the more common sliding hiatal hernia), symptoms may include difficulty swallowing solid foods, abdominal or chest pain, shortness of breath, abdominal bleeding demonstrated by black stools or blood in vomit, or a premature feeling of being full after eating. If these symptoms develop, seek an evaluation from our bariatric surgeon or another qualified physician as soon as possible.
Treatments for Hiatal Hernia
Medication and Lifestyle Changes
Depending on the symptoms and severity of the condition, treatment to ease acid reflux or heartburn may begin with medications to neutralize stomach acid (antacids), reduce acid production (H2-receptor blockers), or prevent acid production (proton pump inhibitors). It may also be helpful to eat smaller meals throughout the day, avoid eating too close to bedtime, and refrain from consuming spicy, acidic, and citrus foods, chocolate, caffeine, and onions. Additionally, eliminating smoking and tobacco products, as well as alcohol, is recommended.
Physically, patients find success by raising the top portion of their bed by at least 6 inches and limiting bending over or lying flat after eating.
Surgical Hiatal Hernia Repair
For larger-sized hiatal hernia repair or severe symptoms from acid reflux and heartburn, Dr. Parrish may recommend one of two different types of advanced laparoscopic techniques—each performed via very small incisions to enable a shorter recovery period and less visible scarring:
- Laparoscopic Nissen Fundoplication – wraps part of the stomach around the lower end of the esophagus to tighten/reinforce the lower esophageal sphincter (LES)—where the esophagus meets the stomach—to protect the esophagus from acid reflux.
- The LINX® Reflux Management System – implants the LINX® device (a flexible band composed of magnetic titanium beads) around the LES to help resist gastric pressure and acidic contents.
Although hiatal hernias may be unavoidable, individuals may be able to decrease their prominence by losing excess weight, not straining during bowel movements, and being particularly careful when lifting overly heavy objects (or avoiding that action altogether).
For more information about hiatal hernia repair and GERD-related conditions, or to schedule a consultation with Dr. Parrish, please contact our practice today.
Medical Resources:
Healthline: Hiatal Hernia
*NIDDK: Definition & Facts for GER & GERD