A hiatal hernia: what it means

Press, 13 November 1985, Page 46

A hiatal hernia: what it means

DOCTOR’S ADVICE

From the College of General Practitioners So your family doctor tells you you have a hiatal hernia. Just what does that mean? Think of eating. Food is chewed and swallowed. It passes down the oesophagus, or gullet, to the stomach. There is a sort of valve where the lower end of the oesophagus passes through the diaphragm — necessary because the bag-like stomach holds the food for a time while it is mixed with acid and digestive enzymes. While the stomach wall is protected by a “mucous barrier” from self-digestion with these substances, the oesophagus is not; hence the need for a valve to stop the mix of food, acid and enzymes going back up. That valve is the critical problem with hiatal hernia. If the hole (hiatus) in the diaphragm is too big, part of the stomach protrudes (herniates) through the diaphragm into the chest, the valve no longer works efficiently, and corrosive stomach contents can burn the lining of the oesophagus. In a word, heartburn. These hiatal hernias vary greatly in size, and the severity of symptoms seems to bear little relationship to the size. Some people have symptoms that are quite disabling with little evidence of a hernia, while others have no symptoms, but at X-ray prove to have quite a large proportion of the stomach in the chest.

Why the enlargement of the hole? You may have been born with a weakness there, or you may be one of the rare cases where a violent blow to the abdomen has caused rupture of the diaphragmatic muscle fibres. Much more likely though, is that you have put on some extra weight, and the pressure in the abdomen has increased, pushing part of the stomach up through a widened hiatus.

The symptoms are heartburn, an acid indigestion, a burning sensation behind the breastbone, hot acid liquid coming up into the throat

and mouth. Both symptoms worsen when gravity assists the passage of acid upwards, when stooping or in bed at night For some, the burning of the oesophageal lining is severe, causing ulcers and bleeding.

The diagnosis is commonly made at an X-ray called barium meal, when a barium salt opaque to Xrays, is swallowed and outlines the stomach. Today’s fibreoptic instruments for looking directly at the stomach and oesophagus are flexible, and this technique is rapidly supplanting, or at least supplementing, the Xray techniques.

For a few, surgery may be needed, but most sufferers can go a long way toward helping themselves. Reduce the pressure pushing acid stomach contents up into the oesophagus. Lose weight (the most important single action a heartburn sufferer can take if he or she is over-weight.) Loosen tight clothing. Get a job that does not entail heavy lifting. Let gravity assist you. Bend from the knees, not from the waist, especiall when lifting. Use 10cm blocks (books, bricks or a nailbox) under the head of the bed. Reduce the amount of acid you produce. Give up the drugs that make the stomach produce more acid (caffeine in tea, coffee and cocoa; tobacco; alcohol); try to reduce tension and anxiety, alter your diet to avoid the foods that make you suffer. For most of us they will include rich, fatty and heavily-spiced foods, but each of us will have his or her own worst enemy. If these measures are not enough to relieve the symtoms, your G.P. may prescribe medications to reduce acidity. These may include simple antacids that, to a small extent, neutralise acid, Maxolon that makes the stomach

empty more quickly, or cimetidine (Tagamet) that actually inhibits acid production by the stomach.

The kind of medication to suit your particular needs is best worked out with a doctor who knows your history, and who has records of your reactions to medications in the past.