What is it?

The diaphragm is a large dome-shaped muscle that separates the chest and abdominal cavity and assists in breathing. It has a hole, called a hiatus, which the esophagus (the tube connecting your mouth and stomach) goes through to reach the stomach. If there is a weakening of the muscle tissue, part of the stomach can push up through the diaphragm into the chest cavity; this is called a hiatal hernia. There are two main types of hiatal hernias, sliding, and paraesophageal. The sliding type is much more common, occurring about 95% of the time. With this type, the stomach and esophagus together simply move up through the hole. In a paraesophageal hernia, the stomach and esophagus stay in their normal places in the abdomen, but a different part of the stomach moves through the hole and sits next to the esophagus. It is thought that the pressure in your stomach, previous injury, increased and continual pressure on the surrounding muscles (this can happen with coughing, straining with bowel movements, vomiting, or lifting heavy objects), and/or being born with a large hiatus may be related to the development of a hiatal hernia. It is more commonly seen in people over 50, and in those who are overweight.

What are the symptoms?

Often there will be no symptoms or problems with a hiatal hernia and you may never know you have one. It may be found incidentally when checking for a different condition. But, as the hernia gets bigger in size symptoms can occur including:

• Abdominal pain
• Heartburn
• Belching
• Trouble swallowing
• A feeling a fullness beneath the breastbone
• Nausea

How is it diagnosed?

As stated, oftentimes, a hiatal hernia is found incidentally when looking for a different condition. It may be seen on x-rays or an upper endoscopy.

How is it treated?

If a hiatal hernia is found, but you are having no symptoms, no treatment is necessary. If symptomatic, treatment may be aimed to block the production of acid (proton pump inhibitors), reduce acid production (histamine blockers), and/or neutralize the acid already present in the stomach (antacids).

If medications are not providing relief, in some people surgery may be an option.

What can I do?

By changing your diet, symptoms, if present, may be improved. Eat several small meals daily and avoid alcohol and foods that trigger symptoms. Make sure you are allowing at least 2 hours between eating and lying down; when lying down to sleep elevating the head of your bed may be beneficial. Losing weight can also be helpful.

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