A hiatal hernia is when part of the stomach pushes upward through your diaphragm. About 15 percent of people in the United States have a hiatal hernia. Most people only experience mild or occasional symptoms. People who develop a small hiatal hernia do not often have any problems associated with the condition. Sometimes, people with small hiatal hernias don’t even know they have one until it is found incidentally by a doctor. However, when people have a large hiatal hernia, food and acid can get backed up into the esophagus, which can cause heartburn.
What causes a hiatal hernia? A hiatal hernia may be caused by weak muscles, a larger-than-normal opening through the diaphragm, obesity, injury to the area, pressure on the stomach from pregnancy, coughing, or straining to have bowel movements which can weaken muscles and put pressure on the stomach. The two major risk factors for developing a hiatal hernia is being age 50 or older, or being obese.
There are usually no real symptoms of a hiatal hernia. However, when people have a hiatal hernia and stomach acid gets backed up into the esophagus, it can cause chest pain, heartburn, and nausea. Many people with hiatal hernia also have gastroesophageal reflux disease (aka GERD). It is more common for people with larger hiatal hernias to develop signs and symptoms. People with larger hiatal hernias may develop symptoms such as heartburn, belching, difficulty swallowing, chest or abdominal pain, feeling especially full after meals, or vomiting blood or passing black stools. Vomiting blood or passing black stools may indicate gastrointestinal bleeding.
As mentioned before, a hiatal hernia is often found incidentally when your doctor is checking for another condition. They are often found when you are being checked for what could be causing heartburn or upper abdominal pain that you are experiencing. Hiatal hernias are often found during the following tests or procedures:
· Blood tests. May involve a CBC, or complete blood count to check for anemia due to blood loss.
· Esophagram (aka barium swallow). The patient drinks a chalky liquid that contains barium which lines the upper digestive tract, which gives a clear picture of the esophagus, stomach and upper part of your small intestine on an x-ray.
· Endoscopy. A thin, flexible tube with a light and camera is inserted down the throat and into the esophagus and stomach to check for inflammation.
· Manometry. A catheter is passed through the nose, down through the esophagus and into the stomach to measure pressure and movement inside the esophagus.
Treatment for a hiatal hernia may include lifestyle changes, antacids, acid-suppressing medications, or surgery.