When your stomach squeezes into your chest

The acid reflux caused by a hiatus hernia can result in heartburn-type symptoms. — Filepic

Over the past year, I have been having heartburn. It usually happens at night, especially when I have a large meal with a lot of meat and fat. It interferes with my sleeping, and I have been having a lot of late nights, leading to tiredness in the morning. This has affected my work. I went to the doctor, and she did a series of tests. She told me I have a hiatus hernia. What is this?

A hiatus hernia happens when the upper part of your stomach bulges through your diaphragm, which is the large muscle responsible for your natural breathing.

Your diaphragm separates your chest cavity from your abdominal cavity.

It has a small opening called a hiatus, through which your oesophagus (the tube that connects your pharynx to your stomach) passes.

Therefore, a hiatus hernia is a hernia (a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it) that occurs at the hiatus.

But why am I having it now? I never had it before my entire life! Why now? And why me?

A hiatus hernia happens when your diaphragm muscle becomes weak.

For most of your life, your diaphragm musculature was taut and strong enough not to be compromised, but now it has weakened enough to allow the hernia to occur.

No one is 100% sure why a hiatus hernia happens in one particular person, but not another, but there are certain causes:

• Ageing
  
  This causes your diaphragm muscles to weaken, although this does not happen to everyone.
  
  Hiatus hernias are most common in people aged 50 and above.
• Injury to the area
  
  This may occur If you have had an accident that damaged that region or surgery that compromised those muscles.
• If you have persistent and intense pressure in your abdominal cavity
  
  For example, if you cough often.
  
  This tends to occur in those who have tuberculosis or chronic bronchitis, or who smoke.
• If you vomit often
  
  For example, people with bulimia – an eating disorder that is characterised by bouts of overeating, followed by self-induced vomiting, purging or fasting.
• If you strain at defecation often
  
  For example. people with constant hard stools or constipation.
• If you consistently lift heavy objects
  
  For example, during gym exercises, body-building or as part of your job.
• If you are obese

Sometimes, you can also be born with an unusually large hiatus in your diaphragm, so you might develop a hiatus hernia at a young age.

This sounds scary. Will having my stomach in my chest cavity interfere with my breathing?

It may. Most small hiatal hernias cause no signs or symptoms, but larger ones can cause:

A CT scan is one of the ways to diagnose a hiatus hernia (circled in red). — Dr ANANTHA KUMAR CHINNASWAMY

• Heartburn
  
  A burning sensation in your epigastric (top of your abdomen) or chest areas, especially after you have taken a large meal or eaten spicy foods.
• Regurgitation of food or liquids into the mouth
  
  This can result in a sourish taste at the back of your throat.
• Acid reflux
  
  This is caused by backflow of your stomach acid into your oesophagus.
  
  You therefore get the burning sensation of heartburn.
  
  Your oesophagal lining also starts to change into the type of lining in your stomach.
• Difficulty swallowing
• Chest or abdominal pain
• Feeling full very soon after you eat
  
  This feels as if your stomach has “no more space” for the amount of food you would usually be able to consume.
• Shortness of breath or difficulty in breathing
• Vomiting of blood or passing of black stools
  
  This may indicate gastrointestinal bleeding and requires an immediate visit to the doctor.

Can a hiatus hernia be diagnosed by an X-ray? I am actually afraid of undergoing a “scope”.

A hiatus hernia, unfortunately, cannot be diagnosed by an X-ray.

You need to undergo endoscopy, a high-resolution manometry, or even a CT (computed tomography) scan.

Many doctors also still do a barium swallow to analyse the size of the hiatus hernia and how it moves.

Don’t worry about the endoscope. Most doctors will give you a general anaesthetic so that you are unaware of the procedure.

Even if the doctor doesn’t give you a general anaesthetic, you will be sedated, so that you are less aware of what’s going on.

It is also a good time to do a colonoscopy to screen for colorectal cancer if you are over the age of 50, as recommended by healthcare professionals.

How can I cure my hiatus hernia?

Most people who have hiatus hernia experience no symptoms at all, and therefore, do not require any medical or surgical intervention.

It is recommended that you do not take large meals, especially before sleeping, and to reduce your weight if you are obese.

For the heartburn-type symptoms, the doctor will give you proton pump inhibitor and H2 receptor blockers medications.

If the hiatus hernia is large and gives you severe symptoms, then surgery is required.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.