Medical opinion: A look at hiatal hernias

Editor's note: Board- certified specialists from a panel of Yuma-area physicians provide to-the-point answers to questions submitted by Sun readers. The answers are only the opinions of the answering physicians and are not meant to be a substitute for medical consultation or physician care. Submit questions by e-mail to medicalopinion@ yahoo.com or via regular mail at Yuma County Medical Society, P.O. Box 4476, Yuma 85366.


BY DALE F. WEBB, M.D.


Q — My mom was recently diagnosed as having a hiatal hernia. Can you please explain more about the disease and treatment?
 
A — Hiatal hernias have been a known entity for most of man's history. Its consequent diseases have only been described accurately since the development of the specialty called "gastroenterology."
 
The understanding of the basic anatomy and physiology of the esophagus and the stomach has been well reviewed and explains most of the consequences when stomach content are allowed to reverse their normal flow and return from the stomach back to the esophagus and up to the back of the throat and occasionally into the larynx and lungs.
 
The basic pathology starts with a poor binding of the esophagus to the diaphragm. Normally the very distal part of the esophagus lies below the diaphragm, which separates the negative-pressured chest from the positive-pressured abdomen. This mechanism creates a "valve-like" action that prevents the acidic stomach contents from entering the relatively alkaline esophagus.

This problem is usually found in overweight adults, but it can be present in children and even in infants, according to recent reports.
 
The natural bindings of the esophagus give way, the valve action is lost and acid and biliary contents reach the esophagus and even the mouth. This process can result in stomach contents seeping into the lungs and cause acute and/or chronic lung problems.
 
The damage done to the esophagus is also consequential. Severe burning in the chest can occur from esophageal inflammation. Bleeding, ulceration and scarring can result from this inflammation.
 
Cancer of the esophagus can be a consequence of this prolonged inflammation that causes changes in the type of cell lining the esophagus. Entry of gastric fluid can be the cause of recurrent lung problem.
 
Fortunately, progress has been made in better treatment. The acidity of the stomach can be reduced with medication. Bed position can be changed. Changes in diet and weight reduction may help.
 
Finally, surgery may be required. Surgical advancements have been remarkable. Procedures can now be done through small incisions in the abdominal wall (laproscopic surgery). With this procedure patients are frequently sent home the day of surgery.
 
Results of treatment have a high rate of success. I believe there are now reports of a reduction in the rate of cancer of the esophagus after hiatal hernia repair. Not all hiatal hernias are symptomatic — but if you have symptoms, see a doctor.


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Dale F. Webb, M.D., is a former Yuma chest surgeon.