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A Hiatus on Reflux
(Hiatus Hernia)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Article printed in August 10, 2007 issue
Reprinted under "Heatburn Could Be from a Hiatus Hernia"
on page 30 in the November 24, 2010 issue of The Mississauga News under the feature: Health & Beauty, Medicine Matters.
Portrait of Dr. Peter W. Kujtan, supplied 2005
Dr. Peter W. Kujtan

A common cause of nagging stomach pain often turns out to be a hiatus hernia. It is not a disease in the true sense, but rather an anatomic anomaly that develops with time. Our stomachs are located just under the diaphragm muscle below the lungs. Food moves down the esophagus tube located between the lungs to reach the stomach. The stomach is a sac-like organ with limits on how much food it can hold and digest at any given time. Sometimes a small part of the stomach can be situated above the diaphragm within our thorax. The great majority of these are of the “sliding” type which means that they balloon up into the thorax and subsequently relax back to where they should be. They tend to correlate with over-eating and abdominal obesity, but are not exclusive to these conditions.

Most hiatus hernias have no symptoms. Others result in heartburn and regurgitation. The nature of heartburn requires a basic understanding of the digestive process. Food moving down the esophagus enters the stomach, and is kept from moving backwards by a weak band of muscle encircling the bottom part of the esophagus. The stomach produces strong acids used to churn and digest our foods.

A hiatus hernia allows this mixture to re-enter the esophagus, which lining is susceptible to inflammation and damage by stomach acid. When this lining is repeatedly irritated and healed, bands of scar tissue appear. This scar tissue is tough and can impair the flow of food producing a condition called dysphagia or “pain on swallowing”. Repeated insult to body tissue is not a good thing. It heals, but occasionally cellular mistakes are made in the rebuilding process and the tissue can mutate, or even progress to pre-cancer and cancer.

These changes are spotted by directly examining the area with an endoscopic camera. The changed tissue is known as Barrett’s esophagus and is usually a signal to engage in close monitoring.

Hiatus hernia is most commonly diagnosed with an X-ray combined with drinking a special liquid, called an upper-GI series. Otherwise, it can be observed directly by a trained gastroenterologist using an endoscope. Treatment is often directed at reversing the causes. Eating small meals and chewing your food helps. Avoid lying down after meals and sleep with your head elevated. Losing weight and not smoking also helps. We also prescribe acid suppressing drugs to lessen the potency of the reflux substrate.

I am surprised at how many people confuse hiatus hernias with inguinal hernias of the groin. They make the mistake of thinking that a quick operation will fix the problem. This is simply not true. A surgical option is generally employed after all else has failed or when the hernia is of substantial size. Avoid changing directions and you will get to where you are going!

Related resources:
Hiatus hernia from Wikipedia, the free encyclopedia.
Hiatus Hernia from BUPA.co.uk. Animation - How a sliding hiatus hernia forms, Symptoms, Complications, Causes, Diagnosis, Treatment.
Hiatal Hernia (Hiatus Hernia). Pronounced: High-AY-tal HER-nee-uh. By Amy Scholten, MPH. Definition, Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Prevention.
Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH).
Hernias Explained from BetterHealth, Victoria, Australia. "A hernia is the protrusion of organs, such as intestines, through a weakened section of the abdominal wall." Symptoms, Different types of hernias, Strangulated hernia, Surgical procedures, Hiatus hernia.

Other Articles by Dr. Kujtan