Hiatus Hernias

Hiatus hernia is an uncomfortable complaint that has been endured by many people for a long time, but until recently surprisingly little has been said about it.

However, as the X-rays of radiologists probe deeply into the body, more and more cases of hiatus hernia are being discovered and doctors are finding that many common symptoms seem to stem from the hernia.

A hiatus hernia is caused by part of the stomach being pushed through the hiatus or aperture in the diaphragm through which the food pipe (the esophagus) passes on its way from the mouth to the stomach.

The diaphragm is a vast thin muscle sheet separating the thoracic cavity, containing the lungs and heart, from the abdominal cavity containing the intestinal system.

Normally the hiatus houses the esophagus alone, but if there is an increase in pressure from below it is possible for part of the stomach to be pushed through the narrow aperture.

Nobody is sure why this happens, but according to Dr. Denis Burkitt, who visited Australia a few months ago, it happens mainly to people who do not take enough bulk and fiber in their daily diet. These people are forced to strain when having a bowel action and this pressure passes along the intestinal tract, the pressure sometimes being responsible for hiatus hernias.

Dr. Burkitt says that simply adding unprocessed bran to breakfast will reduce the need to strain, ease the intestinal internal pressures, and relieve the condition.

Dr. Burkitt has gained world renown for his work with bran, or fiber and fiber will bring a great deal of relief to many sufferers.

A hiatus hernia is often accompanied by an oesophageal reflux. This means that the lower end of the food pipe, which houses a valve to let food pass, is often weakened by the strains and stresses, and instead of staying closed most of the time, it opens.

This allows the very powerful acid, contents of the stomach to regurgitate, or “reflux” back into the lower end of the food pipe.

This all causes a great amount of misery, which, if not serious is annoying. A typical symptom of a hiatus hernia is radiating discomfort, usually at the lower end of the breast-bone. The pain has often been mistaken for an impending heart attack!

A full-bloated feeling is also common. Symptoms are more common after large meals, especially when much bending of the body follows.

Diagnosis is usually made from a radiological examination. The hernia, and the “reflux,” can usually be seen quite clearly.

What do you do? Many simple routines have been suggested, and although few are very satisfactory, all give some degree of relief.

Dr. Burkitt’s high fiber intake is a good starting point. It is simple, cheap, and although it tastes like stewed cardboard it can only help. I eat two tablespoonfuls of bran daily.

Overweight people are advised to lose weight. Hiatus hernia is more common in the obese.

A sensible diet, as part of the general weight reduction routine, will certainly make a person feel better and should be teamed with a regular and simple exercise routine.

Why not take a relatively long walk each day or two? It will tone up the system in general, and help you lose unwanted weight.

You’ll also find that the less you stoop and bend the body the better. Bending increases intra-abdominal pressure, and aggravates hiatus hernia. As discomfort often follows meals, sitting upright after eating is also suggested.

Spicy foods, alcohol, and cigarette smoking are known to aggravate hiatus hernia symptoms, increasing personal discomfort.

Medication can often give some relief. The usual range of antacids – take your pick from the vast array – will reduce the acid contents of the stomach. If reflux does take place, it will be less uncomfortable or noticeable.

A fairly new drug, Cimetidine, reduces acid production in the stomach and is claimed to reduce symptoms of a hiatus, hernia.

But Cimetidine must be given under strict medical supervision, as it is essentially used for the treatment of peptic ulcers in the bowel wall.

Recent surgery has entered the field. Once surgery to improve hiatus hernia was considered a large operation and not to be undertaken lightly.

But with improvement in ideas and operative techniques some patients with symptoms that defy simple measures or medical treatment are now undergoing surgery.

One modern operation is called the Nissen fundoplication operation. Its most recent Australian trial was reported from the Westmead Centre in Sydney.

“Twenty-four patients with gastro-oesophageal reflux were treated by Nissen fundoplication over a three-year period,” Dr. O’Rourke reported recently in the Medical Journal of Australia.

“In 22 patients the symptoms of heartburn, reflux, or dysphagia (difficulty in swallowing) were abolished or dramatically improved.”

The operation is considered to be safe, and in the majority of cases, symptoms greatly improved.

Another interesting procedure was reported recently in the Journal of the American Medical Association.

A silastic device in the shape of a small horse-shoe was stitched around the hiatus.

The “horse-shoe” prevented the stomach from pushing itself into the chest area.

Much can be done today for a social condition that still produces a lot of discomforts.

Note: A sensible diet is best. Avoid things that will increase the acid production of the stomach. Spicy foods, alcohol, and smoking aggravate hernia symptoms, increasing discomfort.

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