Normally, a muscle called the diaphragm separates the abdomen and chest. The diaphragm is the main muscle that controls breathing. The esophagus passes from the back of the throat into the chest, behind the heart, down through a hole in the diaphragm called a hiatus to join with the stomach in the abdomen. The position of the stomach and the esophagus as it passes through the diaphragm are important and are maintained by ligaments that hold the structures in proper position.
As you age, the ligaments holding the stomach in place can stretch, and the hiatus in the diaphragm can enlarge. The result is that part of the stomach can move abnormally into the chest, creating a condition known as a hiatal or hiatus hernia. Normal position of the junction of the esophagus and stomach is required to maintain appropriate strength of the lower esophageal sphincter, a muscle within the wall of the esophagus. The LES is the main barrier to stomach acid reflux. When a hiatal hernia occurs, the LES becomes weaker, predisposing you to reflux.
There are two major types of hiatal hernias, and both increase acid reflux. Typically, people refer to a sliding hiatal hernia. It is called a sliding type because the stomach can slide in and out of the chest. The other type of hiatal hernia is called a paraesophageal hernia. A paraesophageal hernia is a condition in which the stomach slides up into the chest through the hiatus alongside the esophagus. Paraesophageal hernias are more common in those older than 70 years. In a paraesophageal hernia, the stomach is in the chest though its blood supply comes through the diaphragm from the abdomen. The blood supply can be interrupted if the blood vessels twist. Temporary interruption of blood flow can cause nausea, vomiting, and pain. In severe cases, part of the stomach can die off, accompanied by bleeding, pain, and, if untreated, death. For this reason, if you have a paraesophageal hernia, get a referral to a surgeon to have it repaired.
A hiatal hernia does not cause pain. Symptoms you might experience are heartburn and regurgitation. A hiatal hernia causes the LES to be less effective, resulting in acid reflux, but the hiatal hernia itself really has no symptoms. Many patients report dyspepsia, which is the feeling of a “sour stomach,” and they think that means they have a hiatal hernia. But dyspepsia is a nonspecific stomach disorder treated with a proton pump inhibitor (PPI).
The chance of developing a hiatal hernia increases with age. Complications of a sliding hiatal hernia are ulcers with possible bleeding. Frequently, patients are referred for evaluation for anemia. Anemia is a low blood count and is from either blood loss or inadequate blood production. Low iron stores in the body frequently cause anemia because iron is required to make red blood cells. The initial evaluation for iron deficiency anemia is a colonoscopy to rule out a bleeding cancer. A small amount of long-standing bleeding depletes iron stores. Once a colon-bleeding source has been eliminated, an upper endoscopy test is done. This can show whether a large sliding hiatal hernia contains ulcers that bleed chronically. Very rarely, a cancer can form in a hiatal hernia and can bleed chronically, resulting in anemia.
By Mortin - Copyright 2009
Last modification 31/12/2009
What is a Hiatal Hernia? - References