Hiatus hernia is the Lon Chaney of internal distresses: it’s the condition of 1000 faces – all of them scarier than the real one. On any given day, a stiff, frightening chest pain could send you to the hospital labelled as a possible heart attack victim. (And that’s what you might be, so don’t take any chances.) But if what you really have is a suddenly apparent, kicking and screaming hiatus hernia, your doctors, at first glance, might think you are having either a coronary, biliary colic, pancreatitis, a gastric or duodenal ulcer, a disorder of the oesophagus (gullet), a digestive malfunction, angina or anyone of many other good but wrong guesses..
It’s really a sheep in wolfs clothing, though, and hardly a rare, exotic disease. Estimates as to the number of people who have hiatus hernias go as high as 18 per cent, and most don’t even know they have them. It’s a sneaky – and, usually, asymptomatic – little digestive-tract devil. And, more often than not, it is nothing much to worry about, despite the pain.
What is hiatus hernia?
A normal oesophagus, in its long, narrow descent from the mouth to the stomach, must pass through a taut sheet of muscle: the diaphragm, which may be thought of as both the floor of the chest and the ceiling of the abdominal cavity. To get to the ‘stomach, the oesophagus pokes through a teardrop-shaped opening in the diaphragm called the hiatus. It’s at this point that the oesophagus and stomach join, and where a valve system (the lower oesophageal sphincter) keeps deposited food (and the acid working to digest it) from backing up into the oesophagus.
In a hiatus hernia, the upper part. of the stomach has slid up past the diaphragmatic hiatus (weakened, perhaps, by age) and into the chest. From 75 to 95 per cent of hiatus hernias are of this ‘sliding’ type. These come and go, sliding back and forth, depending on body position and other factors. In another kind, the ‘rolling’, or para-oesophageal, hernia, the oesophagus – stomach junction stays in its normal location (as opposed to the action of- the ‘sliding’ type), but a portion of the large lower curved section of the stomach rides up through the hiatus and rolls forward in the chest cavity. These ‘rolling’ hernias can be big problems and may require surgery, but they’re relatively rare.
A hiatus hernia, in and of itself, is not a painful condition. Whereas, for example a broken artn. results in pain, a hiatus hernia results for the most part in nothing except an anatomical deviation. The major difficulty associated with ‘sliding’ hiatal hernias is gastro-oesophageal reflux, which is a backwash of stomach juices and which, in the case of hiatus hernias, is probably caused by the stomach’s unnaturally altered position. Reflux happens when the oesophageal sphincter is weak and allows acidic gastric fluids to travel in the wrong direction.
It’s important to know that reflux can happen in somebody who doesn’t have a hiatus hernia. Just because you have heartburn doesn’t mean you have the condition and, conversely, just because you have a hiatus hernia doesn’t mean you’re bound to have heartburn, chest pains, acid backup into the throat or other reflux-associated discomforts. But, then again, you might. A visit to your doctor ought to let you know what your inner story is.
How do hiatus hernias get that way? Nobody’s sure, and it probably varies from case to case. It could be the result of a congenital problem, or a side effect of being pregnant or having given birth, or an offshoot of over-eating or obesity. Any undue increase in abdominal pressure can do the deed. Some researchers believe that straining during defecation can cause the stomach to be pushed up through a weakened hiatus.
Keeping the problem at bay
The usual treatments and advice have little to do, actually, with fixing the hernia itself but rather address the issue of keeping the reflux in check. Some of these bits of wisdom are :-
- Lose weight.
- Avoid bending or stooping.
- Don’t wear tight belts or girdles.
- Avoid alcoholic beverages (and cola drinks, too).
- Don’t smoke (it helps produce stomach acid, which is just what you don’t need more of).
- As with peptic ulcers, eat several little meals every day, rather than a couple of large ones.
- Wait at least 21/2 to 3 hours after a meal before lying down.
- Sleep with your head elevated 8 to 10 inches.
- Avoid drinking coffee and eating chocolate (they weaken the oesophageal sphincter), and avoid acidic foods, such as oranges, grapefruit and tomatoes.
- Be wary of garlic, onion and peppermint, too.
- Avoid taking oestrogen drugs – they aggravate heartburn (among other things).
Studies have shown a link between hiatus hernia and gallstones – where you find one, chances are pretty good that you’ll find the other – and suggest that lack of fibre in the diet is to blame for both. Lowering animal-fat consumption and increasing fibre, especially in the form of bran, prevents gallstones. At the same time, a high-fibre diet increases the size of stools and eliminates the straining that can cause hiatus hernia. Wrote British researcher Denis P. Burkitt, ‘The hypothesis that fibre-depleted die.ts are a major factor in the causation of hiatus hernia is consistent with all that is known of the disease’ (American Journal of Clinical Nutrition, March 1981).
The most serious physical effects related to hiatus hernia have to do with damage to the oesophagus. The acidic stomach juices wash back into it and normally cause only inflammation and irritation (and, one researcher suggests. asthma attacks). Continued reflux, however, can cause ulceration, scarring and, ultimately, blockage of the oesophagus, requiring surgery. And matters get worse if you use aspirin. The aspirin ‘may become trapped for extended periods in the oesophagi of patients with oesophageal hiatus hernia,’ wrote Dr Vernon M. Smith; this trapping action allows the aspirin to ‘injure alkaline mucosa by direct contact.
By cutting out acidic foods – especially citrus fruits and fruit juices – in order to avoid complications, some reflux hiatus hernia sufferers have come down with vitamin C deficiencies bordering on scurvy. For these people, vitamin C supplements are probably just what the nutritionist ordered.
Many doctors will cavalierly prescribe frequent antacid use to patients with hiatus hernia related heartburn problems. The antacids will cover up the hurt – but long term consumption of antacids containing aluminum compounds could leach your body of calcium, resulting in the thinning of your bones and bone pain.
Only the most severe cases warrant surgery. If there is a potential of the herniated stomach pinching off the oesphagus, bleeding, or danger of lung or heart damage, then an operation is necessary. But only about 5 per cent or less of hiatus hernia patients require anything other than good medical advice and a change in habits. Besides its general uselessness, unwarranted hiatus hernia surgery also can be risky, and may itself produce new symptoms far worse than any associated with the original discomfort. It’s best to get a second opinion.