…more prevalent in older patients
By Romila Boodram
HEARTBURN and regurgitation do not always signal that you have GERD (gastroesophageal reflux disease), even though that is a common condition linked to these symptoms. A large hiatal hernia can allow food and acid to back up into your esophagus, also leading to these symptoms.

A hiatal hernia happens when the top of your stomach bulges through an opening in your diaphragm. This is a prevalent condition, especially as you get older. It doesn’t always cause symptoms, but when it does, they’re usually related to acid reflux.
Hiatal hernia is often diagnosed by endoscopy, barium swallow test, or a Chest CT scan.

There are different types of hiatal hernia. The sliding hiatal hernia is mostly seen in patients who visit the Georgetown Public Hospital Corporation (GPHC). This is where the stomach intermittently slides up into the chest through the small opening in the diaphragm.

While smaller hernias aren’t usually problematic, larger ones make themselves known with uncomfortable symptoms.
Some of the symptoms associated with a hiatal hernia are heartburn, noncardiac chest pain, indigestion, burping and regurgitation, difficulty swallowing or a lump in your throat when you swallow or sore throat and hoarseness when you speak, due to irritation from the acid.

Dr Yaritza Lopez, Consultant Gastroenterologist and Master Infectious Diseases attached to the GPHC, explained that a hiatal hernia is something you may have and don’t even know.

“It could be an incidental finding let’s say you are doing a test for something else and the doctor sees you have it and you may not have any symptoms at all. It can be symptomatic also depending on the size of the hernia or it can become symptomatic at certain stages like when you put on weight, pregnancy, or you are constipated.”

The gastroenterologist further explained that hiatal hernia becomes a problem when there is a change in the anatomy.
“You can have hiatal hernia long ago but you don’t have any symptoms but then you gain weight or become pregnant and you start having symptoms. So, let’s say, you solve any of the issues, you lose weight or you are no longer pregnant, your symptoms may go away.”

Sliding hiatal hernia is more common and according to Dr. Lopez, most women have gotten this type of hernia during pregnancy because of the abdominal pressure when they deliver a child naturally. Surgeries are done at the hospital but are only recommended when the hernias are big and affect the quality of life.

Dr. Oneka Daniels, Medical Registrar and Gastroenterologist at GPHC said that hiatal hernias are seen in at least 70 percent of the patients at the clinic, especially the older patients. Medications are used to manage most of these cases.

She added that there are other types of hernias that you may see in patients like paraesophageal hernia which occurs when part of the stomach moves up into the chest through a hole in the diaphragm. This type of hernia is a bit more complex and would need to be repaired depending on the size.

While most people with a hiatal hernia don’t experience any signs or symptoms, those who experience symptoms, such as recurrent heartburn and acid reflux, are often advised to make lifestyle changes, such as eating meals at least three to four hours before lying down, eating moderate to small portions of foods, limiting fatty foods, acidic foods, foods containing caffeine and alcoholic beverages, losing weight or maintaining a healthy weight, sleeping in a slightly elevated position and quit smoking.
Antacids or acid suppression medicines are also prescribed to help patients’ acid reflux and heartburn.