The diaphragm separates the chest cavity from the abdominal cavity. Normally, the esophagus passes through a hole in the diaphragm called the diaphragmatic hiatus before it joins the stomach.
The connection of the stomach and the esophagus is called the gastroesophageal junction. This is usually just below the diaphragm in the abdominal cavity. For about 15% of adult Americans, the junction and part of the stomach is located above the diaphragm. This is called a hiatal hernia.
The condition is common in patients with gastroesophageal reflux disease. Patients with a hiatal hernia have a weak muscle at the gastroesophageal junction, making the gastroesophageal reflux worse.
The symptoms of hiatal hernia are usually the same as those for gastroesophageal reflux disease. These include:
- Heartburn
- Undigested food that comes back up
- Belching up a sour substance
- Nausea, especially in the morning
- The sensation of something in the throat
- Severe chest pain after eating. This is often the case when there is a large hiatal hernia with all or most of the stomach located above the diaphragm. This symptom suggests that the stomach is twisting. Twisting causes the blood flow to the stomach to be too low. This is a dangerous situation that needs prompt attention.
Hiatal hernia associated with heartburn is treated the same way as gastroesophageal reflux disease - with lifestyle changes and medical treatments.
- Raising the head of the bed four to six inches
- Avoiding alcohol, chocolate and caffeine
- Avoiding overeating
- Eating or drinking nothing two to three hours before bed
- Avoiding greasy, fatty foods
- Losing weight
These include:
- Antacids that offset having too much stomach acid
- Drugs that lower acid production by the stomach. Two types of drugs do this: histamine 2 receptor blockers and proton pump inhibitors.
- Surgery to tighten the junction between the stomach and esophagus. The most common surgery is done by pulling the stomach back below the diaphragm and wrapping the top of the stomach around the junction between the stomach and esophagus. The stomach is then sewn in place. Surgery is the only way to treat a hiatal hernia that is causing severe symptoms.
