Your digestive system is supposed to be a one-way street. Food goes in the mouth, down the throat, gets broken down in the stomach, travels through the intestines, and leaves through the other end with no backtracking in between. Consequently, when parts of the digestive tract try and go backwards, problems develop. Gastroesophageal Reflux Disease (GERD) is when stomach acid washes back up into the esophagus and causes various uncomfortable and sometimes embarrassing symptoms. It is a common ailment that around 60 million Americans deal with and they generally have episodes of GERD at least once a month.
There are several factors that can contribute to the development of GERD, such as smoking, obesity, or alcohol. Near the top of the list of risk factors is having what is called a “hiatal hernia”.
What Is a Hiatal Hernia?
A hernia is when part of the body ends up sticking out of where it is normally supposed to reside. A hiatal hernia is when part of the stomach protrudes through the hiatus—a hole in the diaphragm that connects the esophagus to the stomach. A hiatal hernia can provoke and promote the symptoms of GERD because the protruding stomach makes it easier for digested food and acid to wash back up into the esophagus.
What Causes a Hiatal Hernia?
The hiatus is normally strong enough to prevent the stomach from poking through. However, various factors can contribute to weakening the muscle lining of this opening and make it easier for a hernia to form. This can include injury, age, or recurrent pressure on the area from repeated coughing, vomiting, lifting heavy objects, or straining during a bowel movement. Some people are also simply born with a larger hiatus than normal which makes it easier for a hernia to form even without the muscles being weaker.
Symptoms of a Hiatal Hernia
Smaller hiatal hernias (where there is less protrusion) do not normally produce symptoms and are often discovered by accident when the doctor is checking you for something unrelated. Larger hernias can lead to GERD, which is a problem since the esophagus doesn’t have the same protective lining that the stomach does. As a result, hiatal hernias share symptoms with GERD:
- Excessive belching
- Difficulty swallowing
- Chest pain
- Hoarseness or sore throat
- Sour taste in mouth
- Coughing up or vomiting blood (from injured esophagus tissue) or passing black stools (from digesting the blood instead)
- Periods of excessive saliva production
Symptoms may be worse after eating a meal or when lying flat. Additionally, long-term GERD can sometimes cause more serious symptoms such as a narrowed esophagus, severe inflammation, or even pneumonia from breathing in stomach acid. The pain of GERD is sometimes mistaken for a heart attack and vice-versa. If you are experiencing chest pain along with any of the following, it is possible that GERD is not the cause and you should seek medical attention:
- Shortness of breath
- Jaw pain
- Arm pain
Treating a Hiatal Hernia
Hiatal hernias are normally not treated directly and are instead left and monitored to see if they shrink or not. Surgical repair is possible but this is usually only done if someone is experiencing one of the more severe complications like pneumonia or esophageal inflammation and other measures have failed.
For non-surgical solutions, there are several types of medicine that can be obtained over-the-counter or with a doctor’s prescription. There are antacids that temporarily neutralize stomach acid, drugs that lessen acid production, and proton pump inhibitors that can both block acid production and promote healing of the esophagus.
Lifestyle adjustments are also key to reducing the GERD symptoms that your hiatal hernia is producing. Your body does not maintain stomach acid at set levels—it increases production in response to certain things about your diet. By making certain adjustments to your eating and lifestyle habits, you can keep acid production to a minimum and decrease the amount that can get into the throat. Lifestyle adjustments you can make include the following:
- Avoid certain foods: Chocolate, onions, spicy food, citrus, and tomato-based foods are more prone to raising the intensity of your stomach acid. Alcohol has a similar effect as well and should be avoided. Fatty meats and “heavy” meals are best left out as well since these can increase acid production. It is also advisable to avoid carbonated drinks since they increase the likelihood of acid splashing upwards into the esophagus. Herbal teas are safe for the most part, just avoid peppermint types and you’ll be fine.
- Lose weight: As mentioned above, one of the causes of a hiatal hernia is when increased pressure weakens the muscle lining of the hiatus. Obesity or being overweight can contribute to this so working to lose weight can help improve recovery or at least decrease the chance of the hernia growing.
- Stop smoking: In addition to the many negative health effects of smoking, cigarettes put strain on the lungs and create a good deal of coughing, which can weaken the hiatal lining.
- Avoid eating large meals: Stomach acid production is largely related to the volume of food you consume at a time. Eating a large meal in a single sitting creates much more acid than eating the same amount over an extended period. When possible, break up your eating habits so you consume smaller amounts throughout the day rather than the standard breakfast, lunch, and dinner series of larger meals.
GERD and hiatal hernias are uncomfortable and can be disruptive but don’t pose any significant health risks overall. However, if you try to treat your GERD and do not appear to have success, you should consult your doctor about other possible causes. A hiatal hernia may be a cause of GERD but that doesn’t mean it’s the only possibility.
Sources for Today’s Article:
“Diseases and Conditions GERD,” Mayo Clinic web site, July 31, 2014; http://www.mayoclinic.org/diseases-conditions/gerd/basics/treatment/con-20025201.
“Hiatal Hernia,” Mayo Clinic web site, February 3, 2015; http://www.mayoclinic.org/diseases-conditions/hiatal-hernia/basics/definition/con-20030640.
Roth, E. et al., “Hiatal Hernias and Acid Reflux ,” Healthline web site, May 15, 2015; http://www.healthline.com/health/gerd/hatial-hernia#Overview1.