A sliding hiatal hernia occurs when part of your stomach protrudes from your abdomen into your chest cavity, sliding into the chest cavity when you swallow and returning to the abdomen when the swallow is complete. They are most common in obese people, smokers and women over the age of 50. This most common type of hernia generally presents without symptoms. In these cases, it is diagnosed during testing for unrelated health conditions.
Sliding hiatal hernias usually do not cause symptoms, especially when they are small. Larger sliding hiatal hernias, however, cause gastroesophageal reflux disease (GERD) when acid from the stomach flows into the esophagus. GERD causes acid reflux, hearburn, difficulty swallowing, abdominal fullness, regurgitation of stomach juices, shortness of breath, hoarseness, nausea and a chronic cough or sore throat. Large sliding hiatal hernias may also cause Cameron ulcers that appear as erosions on the folds of the stomach near the opening of the diaphragm.
As food is consumed, it travels from the mouth and through the esophagus on its way to the stomach. Just before food reaches the stomach, it passes through the esophageal hiatus, the hole that allows food access to the stomach. When a sliding hiatal hernia is present, this esophageal hiatus opening is larger than normal, allowing part of the stomach to slide up into the chest cavity.
If your physician suspects the presence of a sliding hiatal hernia, an upper gastrointestinal (GI) series of testing will be performed to confirm the diagnosis. Prior to the special x-ray series, you will need to swallow a chalky liquid composed of barium and water to coat the upper and middle portions of your digestive tract. Once the liquid is consumed, x-rays are taken to track the barium's movement through the esophagus, stomach and duodenum. An upper GI endoscopy may also be performed so that your physician may examine the interior lining of your esophagus, stomach and duodenum with an endoscope, a small, flexible imaging instrument, to determine if there are any protrusions.
Once a sliding hiatal hernia is diagnosed, your physician will advise a number of lifestyle changes to avoid worsening of the condition, as well as triggering any GERD episodes. If overweight, it is recommended you work toward a healthy weight to reduce pressure on your stomach. Eat small meals more frequently through the day rather than one or two large meals to limit the stomach from distending. Alcohol, caffeine and spicy foods should be avoided to reduce excess acid production in the stomach. Elevate your head when lying down to prevent stomach acid from traveling up through your esophagus.
If you are experiencing GERD symptoms due to your sliding hiatal hernia, medication is available to alleviate the symptoms and prevent the condition from worsening. You will also be advised to change your diet to avoid trigger foods. If there are complications, lifestyle changes and medications do not provide relief, or the hernia is large in size, hernia surgery may be recommended. Hernia surgery is a laparoscopic procedure during which the surgeon makes several small incisions in the abdomen for the insertion of several instruments and a small camera. Images from the camera guide the surgeon through the procedure to push the protrusion back down into the stomach and create a smaller esophageal hiatus opening.
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