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Hiatal Hernia
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Hiatal hernia

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DIGESTIVE SYSTEM
Diseases & Conditions  

When one part of the body protrudes through an opening into another part of the body, a hernia occurs. Hiatal hernias - also known as diaphragmatic hernias - form at the opening (hiatus) in diaphragm where the food pipe (esophagus) joins the stomach. When the muscle tissue around the hiatus becomes weak, the upper part of your stomach may bulge through the diaphragm into your chest cavity.

Hiatal hernias are common, occurring in about one-quarter of people older than 50. They're especially likely to occur in women and in people who are overweight.

Most hiatal hernias cause no signs or symptoms. You may never know you have one unless it's discovered during a test for another problem. Although small hernias aren't painful, larger ones may allow food and acid to back up into your esophagus, which can cause heartburn and chest pain. Self-care measures or medications can usually help ease these symptoms, although very large hiatal hernias sometimes need surgical repair.

Signs and symptoms

Most small hiatal hernias cause no problems at all. But larger hernias can contribute to heartburn and sometimes to belching or chest pain — common problems associated with gastroesophageal reflux disease (GERD). These signs and symptoms occur when stomach acids back up into your esophagus and tend to be worse when you lean forward, strain, lift heavy objects or lie down. Your symptoms may also be worse during pregnancy.

In rare cases, the part of your stomach that protrudes into your chest cavity may become twisted. This can lead to bloating, difficulty swallowing or even obstruction of your esophagus. Just as rarely, blood flow to your stomach may become restricted, causing severe chest pain and difficulty swallowing.

Causes

Your chest cavity and abdomen are separated by your diaphragm — a large dome-shaped muscle that's responsible for a good part of normal breathing. Your esophagus passes into your stomach through an opening in the diaphragm. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak and the upper part of your stomach bulges through the diaphragm into your chest cavity. Anything that puts intense pressure on your abdomen — including persistent or severe coughing or vomiting, pregnancy, straining while going to the bathroom, or lifting heavy objects — can contribute to hiatal hernias.

A hiatal hernia in turn can cause or contribute to gastroesophageal reflux. This happens when a hernia slightly displaces the lower esophageal sphincter, a circular band of muscle around the bottom of the esophagus.

Ordinarily, the diaphragm is aligned with the lower esophageal sphincter, which relaxes to allow food and liquid to flow into your stomach when you swallow. The diaphragm supports and puts pressure on the sphincter to keep it closed when you're not swallowing. But a hiatal hernia raises the sphincter above the diaphragm, reducing pressure on the valve. This causes the sphincter muscle to open at the wrong time, allowing stomach acid to flow up into the esophagus.

A hiatal hernia can also cause heartburn if the herniated portion of your stomach becomes a reservoir for gastric acid, which can then easily travel up your esophagus.

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