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Hiatal Hernia: Symptoms, Causes, Diet, and Treatment

Posted by Deborah Graefer, L.Ac., MTOM on

Hiatal hernia or hiatus hernia, just like gallbladder disease, can happen with any age, but is a common condition often experienced by older individuals. Statistics show that it affects as many as 60% of people by the time they reach 60 years old. Hiatal hernia can also be developed by people who are obese or pregnant, just like gallstones and other biliary problems. Hiatal hernia and gallbladder disease even share a lot of common symptoms. Those similarities are the reasons why we get a lot of inquiries about the nature of hiatal hernia and its likelihood among gallbladder patients.

In this article, we will be presenting the nature and mechanism of hiatal hernia, its list of symptoms, causes, and treatment. We will also be discussing dysphagia (difficulty swallowing) among hiatal hernia patients and our recommended hiatal hernia diet.

What is Hiatal Hernia?

A hiatal hernia occurs when a portion of the stomach pushes up through the diaphragm. The diaphragm is a large muscle that helps us breathe. It normally lies on top of the stomach, separating the abdomen and the chest. The diaphragm has a small opening called hiatus that serves as a passage way by which the esophagus goes through before connecting to the stomach. Ligaments and membranes seal off spaces between the hiatus and the esophagus. However, a number of factors may cause the swallowing muscles to become inelastic, weak, or strained. This causes unintended backflow. When the stomach bulges up through the opening, food and acid may back up into the throat leading to discomfort, heartburn or esophagitis.

Usually, small hiatal hernias are not much of a problem and self-care such as a better diet and chiropractic adjustments can alleviate the symptoms. A chiropractor can sometimes manipulate a hiatal hernia back into position. Large hiatal hernias, on the other hand, may affect day to day living. And aside from inconvenience, may also cause pain as well as a number of complications.

Hiatal Hernia Symptoms

It is difficult to self-diagnose hiatal hernia just by watching your symptoms as they can mimic a lot of other gastrointestinal or biliary diseases. As mentioned, small hiatal hernias are often asymptomatic. On the other hand, larger ones can cause the following symptoms:

  • Acid Reflux/ GERD
  • Belching and excessive gas
  • Bad breath
  • Difficulty swallowing (Dysphagia)
  • Abdominal pain

Often, these symptoms do not require you to rush to the ER for urgent medical attention. However, it is time to see the doctor when you notice the following:

  • Shortness of breath
  • Chest pain
  • Vomiting of blood
  • Passing of black stools

These must especially be observed by individuals with high blood pressure, history of heart disease, or ones suffering from other related conditions.

Types of Hiatal Hernia

Technically, there are four types of hiatal hernia.

Type 1 – Sliding hiatal hernia

Type 2 – Fixed hiatal hernia

Type 3 – Combination of types 1 and 2

Type 4 – Caused by a large defect in the phreno-esophageal membrane

Ninety-five percent (95%) of hiatal hernia cases are type 1. Sliding hiatal hernia, also called concentric or axial hiatal hernia, happens when the upper part of the stomach slides through the hiatus.

Fixed hiatal hernia, on the other hand, is more serious. It happens when the stomach pushes up the hiatus and stays there. It develops right next to the esophagus and may cause blockage of blood flow to the stomach. Type 2 hiatal hernia may lead to cell death and tissue damage and is considered a medical emergency.

Hiatal Hernia and Gallbladder Patients

Some of our gallbladder patients who also have a hiatal hernia have asked if there is a connection between gallbladder diseases and hiatal hernia. According to current research, is no study that definitely links the two conditions. There is a condition called the Saint’s triad characterized by the simultaneous occurrence of gallstones, hiatal hernia, and colonic diverticulosis. However, the cause and mechanism of Saint’s triad is not yet fully understood. There are other studies proving that neither the presence of gallstones or cholecystectomy pose a risk for the development of hiatal hernia. So, no obvious connection.

Despite this lack of a concrete connection, we have found a few commonalities between gallbladder diseases and hiatal hernia:

  • Their link to GERD – It is common for individuals with hiatal hernia to develop GERD and for GERD conditions to develop a hiatal hernia. This poses the question of whether or not either could be diet related. Similarly, gallbladder patients often suffer from GERD or GERD-like symptoms.
  • Their link to Barret’s esophagus – Related to the first item, Barret’s esophagus is a serious complication of GERD. According to studies, most patients with Barret’s esophagus have hiatal hernia. Similarly, a number of research prove that gallstones increase the prevalence of Barret’s esophagus. Also, the presence of bile mixed with acid in esophageal reflux, as in bile reflux, more commonly leads to Barret’s esophagus than does acid alone. Given these findings, both gallbladder and hiatal hernia patients are at risk of developing abnormal esophageal cells.
  • Similar at-risk groups – Below are some risk factors that significantly increase the development of gallbladder and hiatal hernia:

- Age – older individuals are at a greater risk

- Pregnancy

- Obesity

Hiatal Hernia and Difficulty Swallowing

Many of our gallbladder patients are either maintaining our 30-day protocol or are regularly taking their supplements to keep symptoms at bay. As such, difficulty swallowing all those capsules is a concern for a number of individuals. Incidentally, some of them are also suffering from hiatal hernia. Why does that happen and what can you do about it if you are experiencing the same?

Difficulty swallowing, also known as dysphagia, is one of the hallmarks of hiatal hernia. And the worse the hernia gets, the more dysphagia becomes a concern. Due to repeated acid exposure of the esophagus and its supporting membranes, dysmotility as well as impaired contractility and vigor can happen. Moreover, the acid pocket within the hernia may lead to the inflammation of the mucosa and can turn to the formation of a fibrotic stricture that can develop into an obstruction. Any or all of these are possible reasons why it is difficult to swallow when you have hiatal hernia.

If the hiatal hernia is small, this is less likely to a serious concern and may possibly be remedied by using some swallowing techniques:

1.Dividing food or medicine into small portions.

2.Drinking water or more viscous fluid together with your food or medicine.

3.The “pop-bottle” method.

4.Various head positions (leaned forward, tilted back, or to the side) while swallowing.

Hiatal Hernia Causes

The exact cause of hiatal hernia is still not determined. However, here are some possible causes:

  • Congenital defects – born with unusually large hiatus
  • Traumatic injury to the area
  • Disruption of the esophagus’ membrane due to surgery (example: fundoplication for GERD)
  • Age-related changes to the diaphragm
  • Persistent and intense pressure on the diaphragm area (possibly due to exercise, bowel movement, lifting of heavy objects, etc.)
  • Smoking

Hiatal Hernia Diagnosis and Treatment

There are a number of procedures that can be administered to uncover the cause of heartburn or abdominal pain. These tests will be able to determine if a patient is indeed suffering from hiatal hernia or another condition. Examples are:

  • X-ray of the upper digestive system
  • Upper endoscopy
  • Esophageal manometry

Once hiatal hernia is confirmed and it is symptomatic, your doctor will probably ask you to do some or all of the following:

  • Stop smoking
  • Lose excess weight
  • Avoid drinking alcohol
  • Avoid straining when lifting objects and during bowel movements
  • Watch your diet

Medications may also be prescribed. However, these are often for the management of the backflow and not the repair of the herniation itself. The most common medications are:

  • antacids
  • H2 receptor blockers to reduce acid production
  • proton pump inhibitors (PPIs)

However, I always warn about patients about the long-term effects of these. Medications that disrupt the normal GI acidity can definitely affect digestion, gut microbiota, and immunity. Long-term use may lead to conditions like SIBO, leaky gut, and many more. Moreover, not all acid reflux-like symptoms can be addressed by antacids. In fact, excessive acid is often not the problem. Rather, it is the other way around.  To read more about the disadvantages and possible long-term effects of PPI usage, click here.

Sometimes, a big hiatal hernia may require surgery. This can be done via insertion of a single incision through the chest wall or the use of laparoscopic surgery. Hiatal hernia surgery involves pulling the herniated or blocked stomach down into the abdomen or removing the hernia sac and then making the hiatus smaller.

Hiatal Hernia Diet

Part of lifestyle modification for hiatal hernia management is the careful selection of food. Changing your diet can definitely help with your symptoms. Aside from that, meal sizes, frequency, and timing is crucial. Overeating is a big no-no. It would be helpful if you eat smaller meals several times a day, and only when you are hungry. Also, avoid snacking or eating big meals a few hours before bedtime.

Here are some food and drinks to avoid:

  • Alcohol
  • Caffeine (coffee and tea)
  • Spicy foods
  • Citrus fruits
  • Onions

For those with gallbladder symptoms and hiatal hernia, you may also refer to our gallbladder diet page for an extensive list of good and bad foods. What’s good for the gallbladder will also definitely be good for patients with hiatal hernia. Also, since any food sensitivities cause local inflammation, doing the  allergy-provocation diet to discover what these are and cutting them out is highly advised.

Natural Supplements for Hiatal Hernia

At the moment, there are no available natural supplements for hiatal hernia itself. However, we can recommend Zinc-Carnosine Complex with PepZin GI - 120 ct to help with the management of symptoms like acid and GERD. Zinc carnosine supports the body’s natural healing process as it recovers from ulcers and gastritis. If there is inflammation present, this supplement can also help with its reduction. Lastly, if your doctor has prescribed PPIs or NSAIDs, zinc carnosine can help protect your GI tract from damaged caused by these medications.


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