Diaphragmatic hernia

Overview

With a diaphragmatic hernia (hiatus hernia), an opening is formed in the diaphragm. One or more of the abdominal organs can move upward into the chest through this opening. Typical symptoms include heartburn and acid belching. Preventive measures include a high-fibre diet and the avoidance of excess body weight.

Symptoms

A diaphragmatic hernia promotes the development of acid reflux (when stomach acid flows back into the food pipe):

• Frequent heartburn and acid reflux (in particular after meals and when lying down)
• Nausea, acid belching and vomiting
• Problems with swallowing
• Stomach infection (gastritis)
• Chest pressure behind the sternum

Complication

• After some years of living with this disorder, patients have a higher risk of oesophageal cancer
  

Causes and treatment

Causes

The oesophagus (food pipe) naturally passes through the diaphragm where it becomes the stomach. With a diaphragmatic hernia, this gap is abnormally big. If pressure in the abdominal cavity increases (e.g. when coughing), the stomach or parts of the stomach can move upward into the chest cavity. This repeatedly pushes stomach acid into the oesophagus, which over the long term causes it to become inflamed (oesophagitis).

Risk factors

• Family history of connective tissue weakness
• Pregnancy (increased pressure in abdomen)
• Obesity (increased pressure in abdomen)
• Advancing age
• Low-fibre diet (constipation, increased pressure in abdomen)

Further treatment by your doctor / in hospital

Possible tests

• Endoscopic examination of stomach (gastroscopy)
• X-ray
• CT scan (computed tomography)

Possible therapies

• Medication to reduce the production of stomach acid (proton-pump inhibitors, “gastric protection”)
• Operation (e.g. to reduce the size of the opening)
  

What can I do myself?

• Avoid excess weight
• High-fibre diet
• Avoid alcohol, coffee, high-fat and spicy meals
• Stop smoking
• Don’t lie down immediately after a meal
• Sleep with your upper body raised
  

When to see a doctor?

• Heartburn and acid reflex for a prolonged period
• Persistent pain behind the sternum or in the upper abdomen