Hiatus Hernia Symptoms

 In a way, it's a bit of an error to ask what hiatus hernia symptoms are. This is because an hiatus hernia doesn't necessarily cause symptoms in and of itself. It only causes symptoms if the hernia interferes with the function of the valve-like segment of the last part of the esophagus just before it enters the stomach.

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I know this may be a little confusing. I hope to clarify it here.

First, let's define what an hiatus hernia is (by the way, is also called an hiatal hernia).

A hernia refers to some abdominal organ bulging out through a weak spot. The most common example is a groin hernia. The main sign of this is a bulge in the groin area that comes and goes. The bulge is caused by intestines pushing through a weak spot, often when the person is lifting. When they relax and lay down the intestines slide back into the abdominal cavity and the bulge goes away.

The diaphragm is a muscular layer that separates the chest cavity from the abdominal cavity. The esophageal hiatus is an opening in this muscular layer that the esophagus passes through and immediately meets with the stomach.

If the opening becomes stretched out or the muscles weaken, the stomach can slide up into the chest cavity. This is what an hiatal hernia is.

Although it's not a good idea to have internal organs sliding out of position, the stomach slipping a little ways into the chest won't necessarily cause any problems.

However it can cause problems if it interferes with the function of a short segment of the last part of the esophagus referred to as the lower esophageal sphincter (LES). When it's working properly, this area of the esophagus acts as a one-way valve. It allows what we eat to enter the stomach, but prevents the stomach contents from backing up into the esophagus.

This is important because the gastric digestive juices are highly acidic. The stomach has a specialized lining that is able to tolerate the presence of the acid. The esophagus doesn't have this kind of lining. If acid backs up into the esophagus it results in what is essentially a chemical burn. Not surprisingly, the symptom this causes feels burning in nature. Because it's often in the lower chest, the region we associate with the heart, it's commonly referred to as "heartburn."

The backing up of the stomach acid is called acid reflux or gastroesophageal reflux. This not only can cause the burning sensation of heartburn, it can also severely damage the esophagus if it goes on long enough.

It is true that an hiatus hernia often interferes with the LES function resulting in reflux. However, this is not always the case. It is possible to have an hiatal hernia without having reflux.

Also, you can have reflux without having an hiatal hernia.

In the past, physicians didn't have very good ways of testing for reflux. If someone complained of upper abdominal or lower chest discomfort their main diagnostic tool was an upper G.I. series. In this test the person swallows barium and a series of x-rays are taken. The barium coats the lining of the G.I. tract and makes details show up more clearly on x-ray.

This test would show things like an ulcer or polyp or tumor. It also would show an hiatal hernia. However it wasn't very good at showing if reflux was actually present and it really didn't give any idea of whether or not the lining of the esophagus or stomach was irritated.

Because an hiatus hernia often was associated with reflux, it became common for physicians in that era to tell someone with burning discomfort, an hiatal hernia and no other explanation that their symptoms were from their "hiatal hernia."

There were two problems with this.

First, as more sophisticated studies became available research showed that up to 15% of people with a hernia and burning discomfort didn't have reflux. The symptoms were coming from something else. Obviously, treating the hernia wouldn't improve the symptoms if the hernia wasn't causing the problem in the first place.

Also, many people with reflux don't have an hiatal hernia so it really makes no sense to tell them that their heartburn symptoms are from an hiatal hernia they don't have. If the symptoms sound like reflux, additional testing needs to be done.

The medical community currently tries to be a bit more specific these days. They acknowledge that acid reflux can have several causes and focus treatment on trying to minimize the reflux and minimizing the damage caused by any reflux that does occur.

Diagnosing an hiatal hernia is still important part of the process but it's also important to note that an hiatal hernia in and of itself doesn't cause symptoms. It's necessary to investigate further and see if reflux is actually present.

To be complete, I should also mention that you may hear the problem referred to as GERD, standing for gastroesophageal reflux disease.

I hope this has made the sometimes confusing topic of hiatus hernia symptoms a little clearer.

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