Hiatus hernia
Hiatus hernia medically means the herniation/popping of stomach into the
chest through a hole in the diaphragm. The abdomen contents are entirely
covered and separated completely from the chest by this thick tense muscular
fibrous sheath – the diaphragm. It allows food tube to communicate with the
stomach and blood vessels to communicate with the lower parts through
appropriate tight openings. None other can slip into the chest in normal
condition, since openings tightly hold the food tube or vessels.
However, when diaphragm gets weakened or if intra abdominal pressure
dominates, hiatus hernia can occur. In the case of hiatus hernia, the stomach
as such starts getting into the chest following the food tube or in another
way. More than the pressure symptoms in chest due to the bulge or symptoms of
stomach that herniates, the more one suffers due to hiatus hernia is
the food tube – the oesophagus.
Nature had created each and everything with a special character in our
human body. The natural architecture of the human food tube is one such. The
food tube can propel food into the stomach even in the upside down position. In
the same manner, non-return valve at the junction of the lower end of the food
tube and upper (cardiac) end of stomach will not allow even water in the
reverse direction even if the stomach is full. The natural architecture that
prevents back flow of food is by the following mechanisms:
·
Oesophagus enters (ends in) stomach in an oblique manner.
This oblique joining/ junction enhances the tight closure of valve while the
stomach gets distended or filled up.
·
Stomach lies in the abdomen i.e., completely below the
diaphragm. The one-way valve also lies below the diaphragm. So, the high
intra-abdominal pressure will also influence this valve for tight closure to
avoid back flow.
Usually, hiatus hernia lets the food tube valve go above the diaphragm.
Thus losing natural controls, the valve ends in relaxation and permission of
food and acid contents from stomach into the lower end of the food tube. This
ends further in ulceration and causing burning volcano in the chest – heart
burn. These symptoms often mimic symptoms of heart problems. So, hiatus hernia
keeps patients constantly annoyed with the suspicion of heart trouble.
Types – Hiatus hernia usually arises in two types. They
are
·
Sliding hernia – is the most common type of hiatus
hernia. It is the herniation of stomach in a sliding manner into the chest,
i.e., it just slips up into the chest following the food tube. It can occur
while lifting weight, straining, bending or lying down.
·
Bulging or rolling hernia – is bulging of stomach through
a weak point of diaphragm.
Incidences and causes – Hiatus hernias are reward of
strain or injury or increased abdominal pressure. Overeating, overstraining,
overweight, overtightening may cause hiatus hernia. Strained defecation,
strained urination, strained cough, strained vomiting, etc., can also
cause hiatus hernia.
Hiatus hernias are more common in adults and rare in children. Females
after the age of menopause have usually higher incidences. The diaphragm will
get weakened with age, constant increased intra abdominal pressure, overeating,
multiple pregnancy, etc. Irrespective of sex, obese and aged persons with the
habit of smoking and drinking alcohol will suffer more from hiatus hernia.
Sometimes, congenital short oesophagus can also cause sliding hiatus hernia.
Symptoms
Usually hiatus hernia will not
produce any symptoms in the initial stages. However, it can cause discomfort in
the chest and stomach as hernia increases in size. The major symptoms are
·
Ball like sensation or chest oppression after meal.
·
Sometimes ball like sensation seems to be raising in
chest (due to crawling food tube)
·
Burning pain behind the breast bone (retro sternum pain)
with sour eructations
·
Belching often with chest discomfort
·
Difficulty in swallowing and even a small hand full meal
seems to fill the abdomen
·
Indigestion, nausea and vomiting (of food/occasionally
blood)
·
Anaemia and weight loss when left untreated for a
prolonged time
·
Complaint usually aggravated or triggered by lying down
and bending.
·
Diagnosis
Hiatus hernia can be easily identified with its symptoms of aggravation
following a heavy meal. Anyway, detailed evaluation by a gastroenterologist is
required to reveal the condition clearly and to proceed for apt treatment.
Following tests will give a clear idea about hiatus hernia and its
intensity.
·
Barium meal X-ray series – to confirm hiatus hernia and
its nature of swelling. Also it can rule out obstruction/strictures, if any.
·
Endoscopy tests to confirm oesophagus ulcerations and
hiatus hernia
Biopsy of the ulcers (if any) – to rule out cancer or presence of H. pylori
·
Ultrasound abdomen scan – to rule out other organ
involvement (gall bladder and pancreas, liver, etc)
·
MRI – helps in difficult cases to get diagnosed
·
Finally, it is not out of place to rule out heart
involvement by checking BP and ECG
Complications
The repeated acid reflux due to regurgitation in case of
hiatus hernia will often cause recurrent ulcerations in lower end of
oesophagus. These ulcers often bleed continuously in small quantity to cause
anaemia. Also constant ulcer intends to raise the risk of cancer. Even then,
these ulcers heal; they heal with scar which narrows the oesophagus to cause
difficulty in swallowing. Weight loss results finally due to reduced intake and
anaemia.
Management
DO
·
Try to lose weight as first line of management in case of
hiatus hernia.
·
Have meals slowly in a relaxed manner, without any hurry
or tension
·
Stand or sit erect after eating
·
Sleep in 45 degree elevated bed or keep high pillows
while sleeping
·
Go for a relaxed walk after diet
TAKE
·
Easily digestible and oil free diet to reduce the work
load of stomach
Plenty of juices
·
Meal never more than 3/4th of the stomach
·
Small meal often to neutralise the acid load in the
stomach to avoid acid reflux
AVOID
·
Tight waist belt
·
Stooping, bending, lying down, lifting weights and doing
exercise upside down
·
Habits of smoking, drinking and chewing tobacco
·
Food containing high spices, chilies, pepper, and
sausages
·
Aerated drinks, coffee and tea
·
Overeating/full meal, oily food, pickles and fatty snacks
before bed time
·
Drugs like NSAIDs / pain-killers / birth control pills /
nitrates
General treatment for heartburn
Hiatus hernia as such produces only
pressure symptoms or discomfort feeling whereas recurrent acid reflux causes
oesophagitis, oesophageal bleeding, strictures and obstruction in lower end of
oesophagus. So to avoid / arrest this acid reflux, most of the patients are
prescribed only antacids or H2 blockers as management or treatment with habit
and diet recommendations.
Surgery – In resistant and very painful cases, surgery is
advised as a last resort to remove ulcerated / sclerosed / constricted oesophagus
and to repair diaphragm to correct hiatus hernia. This surgical procedure will
improve dietary intake immediately. Advanced laparoscopic surgery can answer
this hiatus hernia in an easier way.
Homeopathic approach
Without putting off the fire, covering the fire is like adding fuel to it
for a dangerous event. Managing hiatus hernia only with antacids and without
any stress and strain limitation will lead one straightaway to the surgeon’s
table. So, habit alternation and dietary changes should be followed strictly to
manage hiatus hernia whatever the medicine or system followed.
Hiatus hernia need not be operated upon if it is in the initial stages, as
it can be easily managed with Homeopathic medicines. Even though scientific
evidence won’t prove reduction in size of hiatus hernia, hiatus hernia can be
managed with Homeopathic medicines with respect to symptoms. Homeopathy gives
importance to patient symptoms rather than disease symptoms. It also gives
importance to patient’s sensations like ball / raising ball-like sensation in
the chest, block in the chest, gurgling and rolling of wind, relief from
belching / flatus or not, difficulty in bringing up wind, appetite, nausea,
cravings, aversions, aggravating factors, ameliorating factors, etc. As cure is
impossible hiatus hernia can be managed well symptomatically by the use of
Homeopathic medicines.
In severe cases, where most of the stomach enters the chest, there is need
for surgery. Sometimes even after surgery, feeling of discomfort, chest
tightness may continue to persists due to repair done to the diaphragm. Also
one should be aware that even after surgery one has to restrict strain as
before. So, it is better to adopt strain restriction, habit alternation and
dietary changes in the start-up stage itself, to manage the complaints without
the surgeon’s knife.
Homeopathic medicines commonly used in cases of hiatus hernia are Acid nit,
Ambra G, Antim crud, Arg Nit, Ars alb, Asafoetida, Baptisia, Borax, Bryonia,
Capsicum, Carbo veg, Causticum, China, Cocculus, Colocynth, Condurango,
Hydrastis, Ignatia, Ipecac, Iris vers, Kali bich, Lycopodium, Nat mur, Nat
phos, Nux Vom, Phosphorus, Pulsatilla, Rhus tox, Robinia, Silicea, Sulphur,
Symphytum, etc. These Medicines should be taken under the advice and diagnosis
of a qualified Homeopath.
for
new hope
Dr. S. Chidambaranathan, BHMS, MD (Homeo)
Laxmi Homeo Clinic
24 E. New Mahalipatti Road
Madurai, TN 625 001
India
Tel: +91-984-319-1011 (Mob /
Whatsapp)
Clinic : +91-452-233-8833 |
E-mail: drcheena@gmail.com
(Disclaimer: The contents of this column are for informational
purpose only. The content is not intended to be a substitute for professional
healthcare advice, diagnosis, or treatment. Always seek the advice of
healthcare professional for any health problem or medical condition.)