There are many different types of stomach conditions. From acid irritation to ulcers and even cancer, these stomach problems involve some type of disturbance or disorder of the stomach wall. A lesser known condition is a hiatal hernia. It can affect even a healthy stomach. The problem in a hiatal hernia is that a portion of the stomach becomes trapped or pinched in an opening leading to the chest cavity.
Read more on a hiatal hernia.
Location of a Hiatal Hernia
The stomach sits in the upper left quadrant of the abdomen, largely tucked under the lower part of the left rib cage. The esophagus carries food down the chest cavity and empties it into the top of the stomach. Therefore the stomach lies in the abdominal cavity, which is separated from the chest cavity by a large flat sheet of muscle known as the diaphragm.
A small opening in the diaphragm allows the esophagus to pass. This is known as the esophageal opening or esophageal hiatus and towards the middle of the diaphragm, slightly to the left. It is only wide enough for the esophagus but can sometimes become enlarged. In these cases, the stomach can sometimes get trapped and pinched in this opening. This is known as a hiatal hernia.
What Happens in A Hiatal Hernia?
The diaphragm ensures that abdominal organs cannot enter the chest cavity. It serves as a border and barrier but certain structures do not to pass through across the chest and abdominal cavities. The esophagus is one such example. Large blood vessels like the aorta and vena cava also need to pass between the chest and abdominal cavities.
Therefore small openings have to be present in the diaphragm to allow these structures to pass through. Other organs in the abdomen should not be able to fit in these openings or protrude through into the chest cavity. However, this is what occurs in a hiatal hernia. The stomach protrudes into the chest cavity through the esophageal opening.
Even when the esophageal opening (esophageal hiatus) is abnormally enlarged, the stomach barely fits through it. Therefore only a portion of the upper region of the stomach may protrude through. It is a tight squeeze and the stomach becomes trapped in the esophageal opening. It may also be pinched by the muscles around this opening.
There are several reasons why this enlargement of the esophageal hiatus may occur. Any persistently high negative pressure in the chest cavity or increased abdominal pressure may cause widening of this opening. An injury, forceful and persistent coughing, vomiting or straining to pass stool as well as lifting heavy objects may be responsible.
Some people are born with an unnaturally large hiatus and advancing age may cause the muscles around the hiatus (opening) to become weak. Pregnancy may also be a factor in causing a hiatal hernia as the enlarged uterus increases pressure within the abdomen. Obesity also increases intra-abdominal pressure and a hiatal hernia tends to be more common in obese people.
Read more on stomach hernia.
How Do You Know If You Have A Hiatal Hernia
Most hiatal hernias are asymptomatic meaning that there are no signs and symptoms. In fact hiatal hernias are often discovered incidentally during certain diagnostic investigations despite a person not having experienced any symptoms. However, some hiatal hernias may present with the following signs and symptoms.
It is important to note the signs and symptoms of a hiatal hernia are similar to many other stomach and upper abdominal conditions. Most of these symptoms occur because the lower esophageal sphincter (LES) is compromised with the protrusion. The LES normally prevents the stomach contents from flowing backward into the esophagus.
Heartburn is the most common symptom of a hiatal hernia when there are symptoms. This is a burning chest pain or discomfort caused by the acidic stomach contents in the esophagus (acid reflux). Sometimes existing acid reflux is not due to the hiatal hernia but some other condition.
When hiatal hernia occurs in these conditions, then it worsens the reflux and symptoms like heartburn. The reflux in hiatal hernia tends to increase in severity with larger hernias. Therefore heartburn is worse with larger hernias than with smaller hernias.
Regurgitation is where food (undigested or partially digested) from the stomach comes up the esophagus and reaches the throat or mouth. Unlike with vomiting, regurgitation is not as forceful a process. The larger the hiatal hernia, the more severe the regurgitation.
It can occur even when a person is upright but is more likely to occur when bending over or lying flat, especially after eating. Regurgitation is also more likely to occur after larger meals and is usually accompanied by heartburn.
Chest and Abdominal Pain
Apart from heartburn (burning pain in the chest), there may also be other types of chest pain and abdominal pain as well. This pain is more likely to occur in the lower chest or upper abdomen where the esophageal opening lies. It arises from the squeezing or pinching of the trapped stomach in this esophageal opening. The pain eases once the stomach moves out of the opening and back to its normal position. These episodes of pain may occur as attacks that can last from minutes to hours.
A feeling of fullness or bloating after eating even a small meal can also occur with a hiatal hernia. This is not an uncommon symptom to occur in most stomach conditions. Portion of the stomach becomes compressed when it becomes trapped in the esophageal hiatus. It tends to accompany the other symptoms like heartburn.
The herniation can cause an obstruction of the area between the esophagus and stomach. This can cause difficulty swallowing (dysphagia), particularly with solids. It may also occur as a complication of long term acid reflux which may be caused by the hiatal hernia. Difficulty swallowing is more commonly seen with a rolling hiatal hernia.
Other signs and symptoms that may also occur with a hiatal hernia includes:
- Excessive belching
- Vomiting and sometimes bloody vomit
- Blood in the stool which may cause dark to black tarry stools (melena)