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A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Although hiatal hernias are present in approximately 15% of the population, they are associated with symptoms in only a minority of those afflicted.

Normally, the esophagus or (food tube) passes down through the chest, crosses the diaphragm, and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach.

In individuals with hiatal hernias, the opening of the esophageal hiatus (hiatal opening) is larger than normal, and a portion of the upper stomach slips up or passes (herniates) through the hiatus and into the chest. Although hiatal hernias are occasionally seen in infants where they probably have been present from birth, most hiatal hernias in adults are believed to have developed over many years.

The Causes of a Hiatal Hernia.

It is thought that hiatal hernias are caused by a larger than normal esophageal hiatus, the opening in the diaphragm through which the esophagus passes from the chest into the abdomen. As a result of the large opening, part of the stomach "slips" into the chest.

Other contributing factors include:

A permanent shortening of the esophagus (perhaps caused by inflammation and scarring from the reflux or regurgitation of stomach acid), which pulls the stomach up.

An abnormally loose attachment of the esophagus to the diaphragm which allows the esophagus and stomach to slip upwards.

Different Types of Hiatal Hernias.

Hiatal hernias are either:

Sliding

Sliding hiatal hernias are those in which the junction of the esophagus and stomach, referred to as the gastro esophageal junction, and part of the stomach protrudes into the chest.

The junction may reside permanently in the chest, but often it juts into the chest only during a swallow. This occurs because with each swallow the muscle of the esophagus contracts causing the esophagus to shorten and to pull the stomach up.

When the swallow is finished, the herniated part of the stomach falls back into the abdomen.

Para-esophageal

Para-esophageal hernias are hernias in which the gastro-esophageal junction stays where it belongs (attached at the level of the diaphragm), but part of the stomach passes or bulges into the chest beside the esophagus. The para-esophageal hernias themselves remain in the chest at all times and are not affected by swallows.

A para-esophageal hiatal hernia that is large, particularly if it squeezes the adjacent esophagus, may hamper the passage of food into the stomach and cause food to stick in the esophagus after it is swallowed. Ulcers also may form in the herniated stomach due to the disturbance caused by food that is stuck or acid from the stomach.

Fortunately, large para-esophageal hernias are uncommon.

Hope for Hiatal Hernia!

Understanding the processes behind a hiatal hernia and GERD is the first step to treating it.