In between the mouth and the stomach, the esophagus passes through an opening in the diaphragm called the hiatus. If the tissue around the hiatus weakens, part of the stomach or esophagus may push through the opening into the chest cavity-a condition known as a hiatal hernia.

While many people with hiatal hernias do not even know that they have the condition, it can be problematic if left untreated. Because the valve that separates the esophagus and stomach is weakened, stomach acid can move backward into the esophagus and cause pain and inflammation. This is known as reflux esophagitis, and is the cause of most symptoms related to hiatal hernia.

The cause of this weakening of the hiatus is unknown. Researchers believe that increased pressure in the abdomen-caused by obesity or other factors-stresses the tissue, causing it to weaken or tear.

Signs and Symptoms

In many cases, hiatal hernias produce no symptoms. If symptoms are present, they usually include:

Heartburn

Pain in the upper abdomen that may radiate into the neck; especially after large meals or when lying down

Conventional Medical Treatment

Because the majority of hiatal hernias are asymptomatic, a great number go undetected. Fortunately, a small hiatal hernia is unlikely to cause any health problems and is not considered dangerous. If you are experiencing discomfort that may be associated with a hiatal hernia, see your physician, who can take a barium X-ray of the area to locate the hernia. A physician may first recommend sleeping with your head propped up to keep food down in the stomach, eating smaller meals late in the evening, and avoiding snacking-all of which can worsen irritation of the esophagus and stomach.

A number of medications can improve symptoms. These include antacids, Hz receptor blockers (Zantac, Pepcid, Tagamet), omeprazole (Prilosec) and asapride (Propulsid). Surgery is required to repair the condition only in situations where the pain is very severe and all other conservative methods have failed.

Complementaryand Alternative Treatments

Nutrition and Supplementation

Heartburn is a symptom of a hiatal hernia. Drink a glass of water every three hours during the day, whether or not you're thirsty. At the first sign of heartburn, drink a large glass of water. This should relieve the discomfort.

Rather than eating three large meals, eat smaller meals throughout the day. Avoid spicy, fatty, and fried foods, and stay away from coffee, alcohol, tea, and cola. A high-fiber diet prevents constipation and the resulting straining. Nutritionists recommend the following daily supplements:

proteolytic enzymes plus pancreatin (as directed on label)-improves digestion (Do not give to children.)

papaya enzyme (2 tablets 3 or more times daily)-aids digestion and healing; use chewable tablet form

zinc (50 mg, not to exceed a total of 100 mg from all supplements)-repairs tissue; use lozenge form

vitamin A (50,000 IU for 1 month, then 30,000 IU for 2 weeks, then reduce to 20,000 IU; do not exceed 8000 IU daily if you are pregnant)-combats excess acid; use emulsion form

vitamin B complex (100 mg twice daily, with meals)-aids in proper absorption of nutrients

vitamin C (up to 1500 mg)-builds immunity and heals tissues

(Consult your healthcare provider regarding the duration of treatment.)

Traditional Chinese Medicine

Acupuncture Acupuncture may be used to strengthen the spleen to aid digestion.