The walls of the stomach contain muscle. At the junction of the stomach and the oesophagus there is a thickened area of muscle which is called a sphincter. The sphincter acts like a valve. When food comes down the oesophagus into the stomach, the sphincter relaxes. However, it closes at other times to stop food and acid in the stomach refluxing back into the oesophagus. The diaphragm is a large flat muscle that separates the lungs from the abdomen. It helps us to breath.
The oesophagus comes through a hole (hiatus) in the diaphragm just before it joins to the stomach. Normally, all of the stomach is below the diaphragm. The muscle fibres in the diaphragm around the lower oesophagus help the sphincter to keep the oesophagus closed to prevent reflux of acid and food.
A Hiatus hernia is when part of the stomach slides through the diaphragm. Hiatus hernias are common in people over 50. Often they won’t cause any problems, but can give you pain and heartburn.
When you have a hiatus hernia, the valve mechanism (sphincter) where the gullet enters the stomach is ineffective and allows the contents of the stomach, which are acidic to come back up (reflux) and burn the gullet. It may cause a feeling of warmth or burning in your chest, which is called heartburn. If the symptoms persist and are severe this is called (GORE) Gastro Oesophageal Reflux Disease.
The following measures may help to minimise reflux:
- Eat small frequent meals rather than occasional large meals
- Try to avoid spicy foods, coffee, and alcohol as these can make your symptoms worse
- Don’t go to bed on a full stomach
- If you smoke try to stop. Smoking increases the risks of reflux problems
- Lose weigh if you are overweight or obese
- Sleep propped up on plenty of pillows or with the head of the bed raised by about 10cm. Gravity will help to keep the stomach contents in the stomach
- Try to avoid bending and stooping
If your symptoms still persist, you may need to be prescribed medication by your doctor that suppresses acid production
Rarely, a hiatus hernia causes severe symptoms of reflux which are not helped by medication. Therefore, an operation is occasionally advised. During this operation the stomach is put back into the correct position, and the weakened diaphragm around the lower oesophagus is tightened.
What are the possible complications of a hiatus hernia?
Possible complications may occur if you have long-term reflux of acid into the oesophagus, which occurs in some cases. These include:
- Stricture: If you have severe and long-standing inflammation it can cause scarring and narrowing (a stricture) of the lower oesophagus. This is uncommon.
- Barrett’s oesophagus: In this condition the cells that line the lower oesophagus change. The changed cells are more prone than usual to becoming cancerous. (About 1 or 2 people in 100 with Barrett’s oesophagus develop cancer of the oesophagus).
- Cancer: Your risk of developing cancer of the oesophagus is slightly increased compared with the normal risk if you have long-term acid reflux. This small increased risk is slightly higher still in people with reflux plus a hiatus hernia. This is because reflux problems, on average, tend to be more severe in people with a hiatus hernia compared to those without one.
However, it has to be stressed that most people with reflux or hiatus hernia do not develop any of these complications. They are uncommon. Tell your doctor if you have pain or difficulty when you swallow (food sticking), which may be the first symptom of a complication.
If you have any further queries or concerns please contact:
The Day Surgery Unit – 01935 384339