Understanding Hiatal Hernias & How They Are Linked To GERD

December 15, 2023

We all have probably experienced acid reflux at least once in our lifetime, especially when we have the habit of lying down straight after a heavy meal or when we consume certain beverages, such as carbonated drinks or alcohol.

Acid reflux is a common process that occurs in most individuals. It is usually harmless unless it occurs constantly. When acid reflux occurs chronically, it can lead to the development of GERD, which is often associated with chronic chest discomfort, regurgitation, and heartburn.

However, what many might not know is that a hiatal hernia shares similar symptoms with GERD and could actually be the cause of your chronic discomfort.

What is hiatal hernia?

A hiatal hernia is when the upper portion of the stomach bulges up through the diaphragm and into the chest cavity as a result of the weakening of the muscle tissues surrounding the lower oesophageal sphincter (LOS). The LOS is the muscle connection where the oesophagus meets the stomach. It is usually closed so that the stomach acid does not enter the oesophagus.

Minor hiatal hernias are usually quite a common issue and do not cause any physical symptoms. But more severe ones can result in significant discomfort and can cause stomach acid and undigested food to be trapped inside, damaging your oesophagus gradually.

If you suffer from a more major hiatal hernia, some common symptoms that you might experience, as well as are similar to GERD, include:

Heartburn

Non-cardiac chest discomfort or pain

Feeling full as soon as you start eating and a burning type of stomach pain

Food regurgitation and burping

Trouble swallowing

Hoarseness and an irritated or sore throat

We would like to clarify that not everybody with GERD has a hiatal hernia, and not everybody with a hiatal hernia has GERD. However, if you have noticed some of these symptoms occurring more frequently, they should not be ignored and should warrant an immediate gastroenterology visit.

Some other warning symptoms of a hiatal hernia include:

Bad breath

Shortness of breath or difficulty breathing

Pain or pressure in your lower chest or upper abdomen

Diagnosing hiatal hernia and GERD

While both are generally harmless, that does not mean they should be left untended. A more severe hiatal hernia could eventually cause significant damage, and so does GERD. Chronic acid reflux can lead to complications, such as oesophagitis, oesophageal stricture, Barrett’s oesophagus, ischemia, gastritis, or gastrointestinal obstruction.

During a gastroenterology visit, the gastroenterologist will inquire about your symptoms as well as recommend some tests to help determine the condition you have. Some of the tests include:

CT scan to determine any structural abnormalities

Acid probe to monitor how long it takes for your stomach acid to enter your oesophagus

Pressure study to determine your oesophagus’s pressure when you swallow

Upper endoscopy to look into your oesophagus and stomach

Barium swallow, where you will swallow a special liquid that will appear on an X-ray so that the doctor is able to see your oesophagus and stomach better

Types of hiatal hernia

There are two key types of hiatal hernias:

Sliding hiatal hernia: It occurs when the lower part of the oesophagus and the upper part of the stomach slide into the chest cavity. This is usually the case for 95% of patients with hiatal hernia.

Paraesophageal hiatal hernia: It occurs when the upper part of the stomach moves up into the chest cavity, lying alongside the oesophagus and twisting up. It does not happen as often as sliding hiatal hernia and is a more dangerous situation. The twisting of the herniated stomach can result in the cutting of the blood supply to the organ, causing perforation and gangrene.

Treating hiatal hernia and GERD

Fortunately, both conditions can be treated and cured with proper medication and specific modifications to the current lifestyle. Here are some steps to take:

Quit smoking: Smoking can cause your LOS to weaken

Lose weight: Overweight as a result of too much abdominal fat can cause excess pressure to be placed on your stomach

Elevate the head of your bed: Ensure that you do not lie flat while sleeping

Avoid certain foods: Observe what food worsens your symptoms. Some of the common trigger foods include acidic foods like citrus and tomato, spicy food, carbonated beverages, chocolate, onions, and fatty foods

Have more frequent, smaller meals rather than your typical three large meals: If you have to have a large meal, ensure that you consume it early in the day, allowing you ample time to digest

Do not lie down for at least three hours after eating: Do not eat before you sleep too

Over-the-counter medicative treatment includes:

Antacids to neutralise excess stomach acid

Cimetidine and famotidine to reduce acid production

Lansoprazole, esomeprazole, and omeprazole to reduce acid production and promote oesophagus healing

In rare cases, surgery may be recommended to treat hiatal hernia. Fortunately, it is usually carried out using minimally invasive techniques, which means the patient might only need to stay for a night before going home.

Conclusion

Hiatal hernias and GERD share similar symptoms and urgency. While they may not be harmful, they can develop into more severe complications that can cause significant damage and affect your life. Hence, do not take them lightly no matter what.

If you suffer from any of the mentioned symptoms, do not hesitate to reach out to any of GUTCARE’s providers. On top of that, we also treat other conditions and symptoms, from IBS symptoms to fatty liver symptoms. Our team is experienced and eager to help you eliminate or reduce your symptoms, improving your quality of life.