Hiatus Hernia and GERD

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Hiatus Hernia - Overview

This hernia (also called "Hiatal Hernia") occurs in twenty to thirty percent of the population, and under normal circumstances is not considered serious.

In most cases, there is no discomfort and no treatment is required.

However, this is not necessarily the case when a person suffers from GERD

There are 3 types of hernia:

  1. Sliding,
  2. Paraesophageal,
  3. and mixed.
95% are of the non-serious sliding variety.

Be aware, however, paraesophageal and mixed hiatus hernias are more serious and often require medical attention.

These two types are beyond the scope of this article.


The GERD Connection

Although there appears to be a link between the hiatus hernia and GERD, research indicates that neither one actually causes the other. Consequently, a GERD sufferer almost certainly has a hiatus hernia, whereas the hernia patient may not have or develop GERD.


The Diaphragm

The diaphragm is a thin dome of muscle that separates the abdomen from the chest cavity. Its spontaneous up and down movement assists in breathing by collapsing and expanding the lungs. It also pushes downwards during the act of defication, thereby helping to expel body waste.

The ‘hiatus’ refers to the opening in this "roof" of muscle where the food pipe (esophagus) passes through the diaphragm to the stomach.

A hiatus hernia occurs when the hiatus widens and allows a small part of the stomach to bulge into the chest cavity.



In a healthy person without a hernia, the opening in the diaphragm (hiatus) fits snugly around lower Esophageal Sphincter (LES).

When a person swallows, the diaphragm and the LES work in harmony.

Let me explain: The muscles of the diaphragm surrounding the food pipe relax and tighten in conjunction with the LES, thereby reinforcing Mother Nature’s attempts to keep digestive acids from invading the esophagus.

When part of the stomach bulges into the chest cavity as a result of a hernia, it carries the LES upwards and away from the opening in the diaphragm. Therefore, when the two are separated, Mother Nature’s design is partially defeated and the efficiency of the LES is reduced

On top of that, the trapped section of food pipe between the diaphragm and the LES bulges outwards forming a pouch where acids are forced to accumulate.

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The net result?

  • A higher concentration of acid is injected into the food pipe when the LES relaxes spontaneously.

  • Heartburn activity is increased.

  • Nighttime heartburn occurs more frequently.

  • There is greater damage to the inner walls of the esophagus. (See Barrett's Esophagus)
  • There is an increase in heartburn severity. This results in longer episodes, resistance to over the counter medication and more pain.


Possible Causes

  1. Stress.
  2. Smoking.
  3. Pregnancy.
  4. Being overweight or obese.
  5. Violent coughing or sneezing.
  6. Constipation that causes straining when attempting a bowel movement.
  7. Lifting heavy weights or bending deeply at the waist.
  8. Age – people over 50 are more susceptible to this condition.
  9. Drug abuse, notably the use of cocaine.
  10. In some cases, hiatal hernias are congenital or hereditary.


Corrective Surgery

The time-tested corrective surgery for a hiatus hernia is know as the Nissen Fundoplication , named after the surgeon who developed the technique.

Dr. Rudolph Nissen first performed the hiatus hernia procedure in 1955 and published the results of two cases in a 1956 Swiss Medical Weekly. In 1961 he published a more detailed overview of the procedure.

Nissen originally called the surgery "gastroplication." The procedure has borne his name since it gained popularity in the 1970's.


When to Seek Medical Attention

Under certain circumstances you may develop a medical emergency caused by an obstructed or strangulated hernia. This condition causes sudden and severe pain that won't let up.

Call 911 or your local emergency number!

Apart from that, if any of the following symptoms develop, you may be heading for an attack:

  • You vomit often.

  • Have constant difficulty with a bowel movement.

  • Cannot pass gas.

  • Develop chest or abdominal pain.

  • Experience frequent nausea.

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