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All about gastroesophageal reflux disease (GERD, acid reflux) causes of gastroesophageal reflux disease symptoms of gastroesophageal reflux disease complications of gastroesophageal reflux disease diagnosis of gastroesophageal reflux disease treatment of gastroesophageal reflux disease GERD medications surgery for gastroesophageal reflux disease prevention of gastroesophageal reflux disease gastroesophageal reflux disease in infants hiatal hernia Articles in peptic disorders (stomach disease) - gastritis Barrett's esophagus indigestion (dyspepsia) cyclic vomiting syndrome (CVS) Zollinger-Ellison syndrome gastroparesis hiatus hernia peptic ulcer gastroesophageal reflux disease (GERD)

What is hiatal hernia?

A hernia occurs when part of an internal organ or body part protrudes through an opening into another area where it shouldn't. A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. Normally, the esophagus (the tube that carries food to the stomach) goes through this opening. In a hiatal hernia, a portion of the stomach and/or the section where the stomach joins the esophagus (called the gastroesophageal junction) slips

through the hiatus into the chest.

There are two types of hiatal hernias. Sliding is a part of the stomach and the gastroesophageal junction slip into the chest. Sliding hiatal hernias are common, especially in smokers, overweight people and women older than 50. These hernias are related to naturally occurring weaknesses in the tissues that normally anchor the gastroesophageal junction to the diaphragm and to activities or conditions that increase pressure within the abdomen. These activities or conditions include persistent or heavy coughing, vomiting, straining while defecating, sudden physical exertion and pregnancy. The gastroesophageal junction remains in its proper place and only a portion of the stomach slips into the chest. Of the two types of hiatal hernias, paraesophageal hernias are more likely to cause severe symptoms.

Hiatal hernias contribute to reflux, although the way in which they contribute is not clear. A majority of patients with GERD have hiatal hernias, but many do not. Therefore, it is not necessary to have a hiatal hernia in order to have GERD. Moreover, many people have hiatal hernias but do not have GERD. It is not known for certain how or why hiatal hernias develop. When a hiatal hernia is present, there is a hernial sac, which is a small pouch of stomach above the diaphragm. The sac is pinched off from the esophagus above by the LES and from the stomach below by the diaphragm. What's important about this situation is that the sac can trap acid that comes from the stomach. This trap keeps the acid close to the esophagus. As a result, it is easier for the acid to reflux when the LES relaxes with a swallow or a transient relaxation.The esophagus normally joins the stomach obliquely, which means not straight on or at a 90-degree angle. Due to this oblique angle of entry, a flap of tissue is formed between the stomach and esophagus. This flap of tissue is believed to act like a valve, shutting off the esophagus from the stomach and preventing reflux. When there is a hiatal hernia, the entry of the esophagus into the stomach is pulled up into the chest. Therefore, the valve-like flap is distorted or disappears and it no longer can help prevent reflux.

Most hiatal hernias do not require treatment. When a hiatal hernia is associated with reflux symptoms, such as heartburn, you should eat smaller, more frequent meals; avoid eating for at least two hours before going to bed; and sit up for at least one hour after eating. If lifestyle changes do not relieve the symptoms, your doctor will suggest antacids or acid blockers. Many products are on the market, including both over-the-counter and prescription medications. Fewer than 5 percent of people require surgery. You may need surgery to repair the hernia if you have persistent reflux symptoms or inflammation of the esophagus (esophagitis) that is not healing with medication. Your doctor may advise surgery for a paraesophageal hernia that has a risk of incarcerating.

It is difficult to prevent hiatal hernias. However, you can reduce your risk by maintaining a healthy weight and not smoking. To prevent hernias associated with increased abdominal pressure, avoid activities that cause abdominal strain, especially heavy lifting. If you frequently need to strain when you move your bowels, speak to your doctor. Your doctor may prescribe stool-softening medication and/or suggest that you modify your diet to include more high-fiber foods.

More information on gastroesophageal reflux disease (acid reflux, GERD)

What is gastroesophageal reflux disease (acid reflux)? - Gastroesophageal reflux disease (GERD) is a condition in which stomach contents, including acid, back up (reflux) into the esophagus, causing inflammation and damage to the esophagus.
What causes gastroesophageal reflux disease? - Gastroesophageal reflux disease is often the result of conditions that affect the lower esophageal sphincter (LES). Dietary and lifestyle choices may contribute to GERD.
What are the symptoms of gastroesophageal reflux disease? - Heartburn, also called acid indigestion, is the most common symptom of reflux. The most common symptoms in children are repeated vomiting, coughing, and other respiratory problems.
What're the complications of gastroesophageal reflux disease? - Chronic gastroesophageal reflux disease can lead to a number of serious problems, such as bleeding ulcers in the esophagus, and scarring leading to narrowing of the esophagus.
How is gastroesophageal reflux disease diagnosed? - Useful diagnosing methods include barium swallow X-rays, esophageal manometry, esophageal pH monitoring and EGD.
What're the treatments for gastroesophageal reflux disease? - Doctors recommend lifestyle and dietary changes for most people with GERD. Lifestyle modifications are a key component in the management of GERD and should be incorporated into all treatment stages.
What GERD medications treat gastroesophageal reflux disease? - Antacids remain the drugs of choice for quick relief of symptoms associated with GERD. H2-Receptor blockers are indicated for the prevention and relief of heartburn, acid indigestion and sour stomach.
What surgery treats gastroesophageal reflux disease? - Surgery is indicated for a small group of patients with GERD. The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication.
How to prevent gastroesophageal reflux disease with lifestyle? - A correct life style is effective to prevent the symptoms of GERD. Avoid foods that promote opening of the esophageal sphincter and increase acid reflux.
Gastroesophageal reflux disease in infants and children - Infants are more likely to have the lower esophageal sphincter (LES) relax when it should remain shut. Infants are easier for the stomach contents to reflux up into the esophagus.
What is hiatal hernia? - A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. There are two types of hiatal hernias. 
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