Hiatal hernia or hiatus hernia, like gallbladder disease, can happen at any age but is a common condition often experienced by older individuals. Statistics show that it affects as many as 60% of people before reaching 60 years old. Hiatal hernia can also be developed by people who are obese or pregnant, just like gallstones and other biliary problems. The two conditions even share a lot of common symptoms. Those similarities are why we get many inquiries about the nature of hiatal hernia and its likelihood among gallbladder patients.
In this article, we will present the nature and mechanism of hiatal hernia, its symptoms, causes, and treatment. We will also be discussing dysphagia (difficulty swallowing) among hiatal hernia patients and our recommended hiatal hernia diet.
What is Hiatal Hernia?
It occurs when a portion of the stomach pushes up through the diaphragm. The diaphragm is a large muscle that helps us breathe. It normally lies on top of the stomach, separating the abdomen and the chest. The diaphragm has a small opening called hiatus that serves as a passageway by which the esophagus goes through before connecting to the stomach. Ligaments and membranes seal off spaces between the hiatus and the esophagus. However, several factors may cause the swallowing muscles to become inelastic, weak, or strained. This causes unintended backflow. When the stomach bulges through the opening, food and acid may back into the throat leading to discomfort, heartburn, or esophagitis.
Usually, small hiatal hernias are not much of a problem, and self-care, such as a better diet and chiropractic adjustments, can alleviate the symptoms. A chiropractor can sometimes manipulate a hiatal hernia back into position. Large hiatal hernias, on the other hand, may affect day-to-day living. And aside from inconvenience, it may also cause pain and a number of complications.
Hiatal Hernia Symptoms
It is difficult to self-diagnose hiatal hernia just by watching your symptoms, as they can mimic many other gastrointestinal or biliary diseases. Small ones are also often asymptomatic. On the other hand, larger ones can cause the following symptoms:
- Acid Reflux/ GERD
- Belching and excessive gas
- Bad breath
- Difficulty swallowing (Dysphagia)
- Abdominal pain
Are These Symptoms Considered an Emergency?
Often, these symptoms do not require you to rush to the ER for urgent medical attention. However, it is time to see the doctor when you notice the following:
- Shortness of breath
- Chest pain
- Vomiting of blood
- Passing of black stools
Individuals with high blood pressure, a history of heart disease, or other related conditions must especially observe these.
Types of Hiatal Hernia
Technically, there are four types of hiatal hernia.
- Sliding hiatal hernia, Type 1
- Fixed hiatal hernia, Type 2
- Combination of types 1 and 2
- Caused by a large defect in the phreno-esophageal membrane, Type 4
Ninety-five percent (95%) of cases are type 1. Sliding, also called concentric or axial hiatal hernia, happens when the upper part of the stomach slides through the hiatus.
Fixed hiatal hernia, on the other hand, is more serious. It happens when the stomach pushes up the hiatus and stays there. It develops right next to the esophagus and may cause blockage of blood flow to the stomach. Type 2 hiatal hernia may lead to cell death and tissue damage and is considered a medical emergency.
Is it linked to Gallbladder Diseases?
Some of our gallbladder patients who also have a hiatal hernia have asked if there is a connection between the two. According to current research, no study links the two conditions. The simultaneous occurrence of gallstones, hiatal hernia, and colonic diverticulosis characterizes a condition called the Saint’s triad. However, the cause and mechanism of Saint’s triad are not yet fully understood. Other studies prove that neither the presence of gallstones nor cholecystectomy poses a risk for the development of a hiatal hernia. So, no apparent connection.
Despite this lack of a concrete connection, we have found a few commonalities between them:
- Their link to GERD is common for individuals with hiatal hernia to develop GERD and for GERD conditions to develop a hiatal hernia. This poses the question of whether or not either could be diet-related. Similarly, gallbladder patients often suffer from GERD or GERD-like symptoms.
- Their link to Barret’s esophagus – Related to the first item, Barret’s esophagus is a serious complication of GERD. According to studies, most patients with Barret’s esophagus have hiatal hernia. Similarly, a number of research prove that gallstones increase Barret’s esophagus prevalence. Also, the presence of bile mixed with acid in esophageal reflux, as in bile reflux, more commonly leads to Barret’s esophagus than acid alone. Given these findings, both gallbladder and hiatal hernia patients are at risk of developing abnormal esophageal cells.
- Similar at-risk groups – Below are some risk factors that significantly increase the development of both conditions:
– Age – older individuals are at a greater risk
– Pregnancy
– Obesity
Hiatal Hernia and Difficulty Swallowing
Many of our gallbladder patients maintain our 30-day protocol or regularly take their supplements to keep symptoms at bay. As such, difficulty swallowing all those capsules is a concern for a number of individuals. Incidentally, some of them are also suffering from hiatal hernia. Why does that happen, and what can you do about it if you are experiencing the same?
Difficulty swallowing, also known as dysphagia, is one of the hallmarks of hiatal hernia. And the worse the hernia gets, the more dysphagia becomes a concern. Due to repeated acid exposure of the esophagus and its supporting membranes, dysmotility, and impaired contractility and vigor can happen. Moreover, the acid pocket within the hernia may lead to mucosa inflammation. It can turn to form a fibrotic stricture that can develop into an obstruction. Any or all of these are possible reasons it is difficult to swallow when you have a hiatal hernia.
If the hiatal hernia is small, this is less likely to be a serious concern and may be remedied by using some swallowing techniques:
1. Dividing food or medicine into small portions.
2. Drink water or more viscous fluid with your food or medicine.
3. The “pop-bottle” method.
4. Various head positions (leaned forward, tilted back, or side) while swallowing.
Causes
The exact causes of hiatal hernia are still not determined. However, here are some possibilities:
- Congenital defects – born with unusually large hiatus
- Traumatic injury to the area
- Disruption of the esophagus’ membrane due to surgery (example: fundoplication for GERD)
- Age-related changes to the diaphragm
- Persistent and intense pressure on the diaphragm (possibly due to exercise, bowel movement, lifting of heavy objects, etc.)
- Smoking
Diagnosis and Treatment
Several procedures can be administered to uncover the cause of heartburn or abdominal pain. These tests will determine if a patient is indeed suffering from a hiatal hernia or another condition. Examples are:
- X-ray of the upper digestive system
- Upper endoscopy
- Esophageal manometry
Once hiatal hernia is confirmed, and it is symptomatic, your doctor will probably ask you to do some or all of the following:
- Stop smoking
- Lose excess weight
- Avoid drinking alcohol
- Avoid straining when lifting objects and during bowel movements
- Watch your diet
- Manage your stress levels
Medications
Medications may also be prescribed. However, these are often for backflow management and not the repair of the herniation itself. The most common drugs are:
- antacids
- H2 receptor blockers to reduce acid production
- proton pump inhibitors (PPIs)
However, I always warn patients about the long-term effects. Medications that disrupt normal GI acidity can definitely affect digestion, gut microbiota, and immunity. Long-term use may lead to conditions like SIBO, leaky gut, and many more. Moreover, not all acid reflux-like symptoms can be addressed by antacids. Excessive acid is often not the problem. Instead, it is the other way around. Click here to read more about the disadvantages and possible long-term effects of PPI usage.
Surgery
Sometimes, a big hiatal hernia may require surgery. This can be done by inserting a single incision through the chest wall or using laparoscopic surgery. This procedure involves pulling the herniated or blocked stomach down into the abdomen or removing the hernia sac and then making the hiatus smaller.
Diet
Part of lifestyle modification for hiatal hernia management is carefully selecting food. Changing your diet can help with your symptoms. Aside from that, meal sizes, frequency, and timing are crucial. Overeating is a big no-no. It would be helpful to eat smaller meals several times a day, only when hungry. Also, avoid snacking or eating big meals a few hours before bedtime.
Here are some food and drinks to avoid:
- Alcohol
- Caffeine (coffee and tea)
- Spicy foods
- Citrus fruits
- Onions
You may also refer to our gallbladder diet page for an extensive list of good and bad foods. What’s good for the gallbladder will be good for patients with hiatal hernia. Also, since food sensitivities cause local inflammation, doing the allergy-provocation diet to discover and cut them out is highly advised.
Natural Supplements
Currently, there are no available natural supplements specific to this condition. However, we can recommend Zinc-Carnosine Complex with PepZin GI – 120 ct (Available on Amazon) to help manage symptoms like acid and GERD. Zinc carnosine supports the body’s natural healing process as it recovers from ulcers and gastritis. f there is inflammation present, this supplement can also help with its reduction.
To help your body cope with stress, try Premier Max B-ND. This may help boost your brain power, improve your mood, and support your natural detoxification by strengthening the liver.
Lastly, if your doctor has prescribed PPIs or NSAIDs, zinc carnosine can help protect your GI tract from damage caused by these medications.
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References:
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Cameron, A. J. (1999). arrett’s esophagus: prevalence and size of hiatal hernia. he American journal of gastroenterology, 94(8), 2054.
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Kaul, B. K., DeMEESTER, T. R., Oka, M., Ball, C. S., Stein, H. J., Kim, C. B., & Cheng, S. C. (1990). The cause of dysphagia in uncomplicated sliding hiatal hernia and its relief by hiatal herniorrhaphy. roentgenographic, manometric, and clinical study. nnals of surgery, 211(4), 406.
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