Diagnosis of a Hiatus Hernia

A hiatal hernia occurs when a portion of the stomach pushes up into the chest, through the opening in the diaphragm, according to the National Institute of Health. This opening is called the hiatus. The diaphragm is used for breathing and is where your esophagus (food pipe) connects with your stomach. While small hiatal hernias can be barely noticeable, a large one can cause chest pain and heart burn. In the majority of cases home remedies are sufficient but once in a while surgery is required.

Causes

• The exact cause of hiatal hernias remains unknown but anything that places extensive pressure on your abdome--chronic or heavy coughing, lifting heavy objects, pregnancy, straining while going to the bathroom--can contribute to a hernia.

  Hiatal hernias may lead to reflux (backflow) of gastric acid from the stomach into the esophagus.

Risks

• According to the Mayo Clinic, some people are born with a vulnerability to hiatal hernias or an uncommonly large hiatal opening.

  You may be more likely to suffer from the condition if you smoke, are obese or are age 50 or older.

  Children who suffer from hiatal hernias were probably born with it.

Symptoms

• When hiatal hernias are large enough for stomach acids to back up into your esophagus you may experience chest pain, heartburn, belching and nausea.
  These symptoms can become aggravated by leaning forward and lying down.

  In very rare situations the part of your stomach that protrudes into your chest cavity may become tangled or have its blood supply cut off. This may obstruct your esophagus, causing severe chest pain and problems swallowing.

Treatment

• The goal of treatment is to minimize the backflow of stomach contents into the esophagus.

  Over-the-counter antacids (Maalox, Mylanta, Tums) work to neutralize the acidity in your esophagus and provide relief from heartburn symptoms.

  Medications called H-2 blockers reduce the amount of acid emited by your stomach by blocking histamine receptors. Overt-the-counter medications include famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) and nizatidine (Axid).

  If you experience severe heartburn your doctor may prescribe more potent doses of H-2 blockers.

  It can also help to steer clear of large meals and refrain from bending over or lying down right after a meal.

Surgery

• Once in a while when medication and lifestyle changes haven't worked, people with a hiatal hernia may require surgery.

  Your surgeon may make a single incision in your chest wall (thoracotomy) or abdomen (laparotomy).

  In other cases, your surgeon may insert instruments and a fiber optic camera through several small incisions in your abdomen. The operation is then performed while your surgeon views the images on a video monitor (laparoscopic surgery).