- 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.
- 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.
- 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.
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
- 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
- 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
- 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
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.