Is a Hiatal Hernia Causing Your Acid Reflux?
September 9, 2024
In one study, it was found that 95% of individuals with gastroesophageal reflux disease (GERD) also had a hiatal hernia, showing a significant relationship between the two.
As a board-certified general surgeon with a fellowship in minimally invasive techniques, I have expertise in advanced surgical techniques, which allow me to perform complex procedures through small incisions. There are many advantages to having minimally invasive surgery. I tell my patients, "You will be able to return to your life quickly, have less pain, minimal scarring and recover more quickly than traditional open surgery." One of the conditions I often treat with minimally invasive surgery is hiatal hernia.
What is a Hiatal Hernia?
A hiatal hernia occurs when part of your stomach pushes up through a small opening in your diaphragm, called a hiatus, and into your chest. The diaphragm is the muscle that separates your stomach and chest and helps you breathe. Typically, your stomach sits below the diaphragm, but with a hiatal hernia, part of it slips up through a small opening where the esophagus – the tube that delivers food and fluids to your stomach – passes through to the stomach. The stomach then pushes up through the hiatus into the chest and loses its ability to keep acid from refluxing into the esophagus and throat.
There are four different types of hiatal hernias.
Type 1 hernias (or sliding hernias) are the most common and are caused by the stomach sliding through the diaphragm and into the chest.
Types II, III and IV hernias (or paraesophageal hernias) occur when a part of the stomach protrudes into the chest adjacent to the esophagus. The stomach is then 'trapped' above the diaphragm because it cannot slide through; these hernias are less common but more dangerous.
The exact cause of hiatal hernias is unknown but may be due to factors like:
- Age-related changes in your diaphragm
- An injury to the area, for example, after trauma or certain types of surgery
- Being born with a very large hiatus
- Constant and intense pressure on the surrounding muscles that can happen from coughing, vomiting, straining during a bowel movement, exercising or lifting heavy objects
Symptoms of Hiatal Hernia
If you have a hiatal hernia, you may experience the following symptoms:
- Chronic acid reflux
- Trouble swallowing
- Chest or abdominal pain
- Feeling full soon after you eat
- Shortness of breath
- Vomiting of blood or passing of black stools, which could mean bleeding in the digestive tract
- Chronic Acid Reflux & Hernias
Symptoms of hiatal hernias can include chronic acid reflux, also called GERD. GERD is estimated to affect about 20% of adults in the United States. For acid reflux to occur, the muscle at the bottom of your esophagus, your lower esophageal sphincter (LES), weakens and stomach acid passes through to go back up your esophagus. The resulting burning sensation you may feel is heartburn, but other symptoms include regurgitation, belching or a sour taste in your mouth.
Acid reflux is common after eating tomato-based foods, carbonated drinks, chocolate, coffee and alcohol. Acid reflux occurring at least twice a week for a few weeks is considered “chronic.” There are varying levels of GERD, which can be diet-induced. A change in dietary habits can drastically reduce symptoms, but this may not always solve the problem.
While acid reflux is temporary, GERD shows an underlying issue preventing the food from being kept in your stomach.
Diagnosis & Treatment
If you do not have relief from your symptoms after a change in diet, talk with your doctor about medication and tests to determine the underlying cause – you could have a hiatal hernia.
When a patient is experiencing intense GERD symptoms with no relief, our team of medical experts would perform a series of tests to determine if you have a hiatal hernia and may include a chest x-ray, upper endoscopy (EGD), upper gastrointestinal (GI) series or barium swallow or an esophageal manometry. While these are different tests, the results show whether the acid reflux is caused by a hiatal hernia.
If you do have a hiatal hernia, our team at TMH Physician Partners – General Surgery can help you better understand this condition and discuss your surgical treatment options.
Surgical Options For Life-Changing Results
If surgery is right for you, we can perform a hernia repair and reflux procedure at the same time. At TMH, we use the help of a robotic surgical system to fix the hernia and pull the stomach back to its normal placement. Robotic-assisted surgery is a form of minimally invasive surgery that substantially reduces disturbance to surrounding tissues, providing a variety of benefits to the patient:
- Shorter recovery times because less tissue is disturbed, meaning less pain and discomfort for the patient.
- Minimal scarring due to smaller incisions.
- Patients can typically go home faster than with traditional surgery.
- Reduced risk of complications such as infections and blood loss.
Once the hernia repair is done, we proceed with either a fundoplication (stomach wrap) or placement of a LINX reflux management system device.
In a fundoplication, the stomach (or fundus) is wrapped around the bottom of the esophagus. This repairs the valve at the end of the esophagus that doesn’t work properly.
Some patients opt for a LINX reflux management system device. LINX is a quarter-sized flexible ring of small magnets placed around the LES. The ring expands when food is swallowed to allow it in the stomach, then uses the magnets to close the LES and prevent acid reflux from occurring. This does not require any alteration to your stomach’s anatomy and has a typical 24-hour discharge timeframe.
Following hernia repair and reflux surgery, we often see great outcomes for patients, improving their quality of life thanks to a complete resolution of their reflux.
If you’re experiencing chronic acid reflux, talk with your primary care physician to see if hiatal hernia could be the cause. They can refer you to our team at TMH Physician Partners – General Surgery, or you can make an appointment by calling 850-877-6212.
