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Tummy troubles: hiatus hernia and reflux TUMMY TROUBLES: HIATUS HERNIA AND REFLUX
Q. This seems to be the 'in disease' at present.
A. True, and many people have the condition in various degrees. Fortunately it is seldom serious, never life-endangering and will not develop into cancer.
Q. What causes it?
A. Hiatus hernia, also commonly termed diaphragmatic hernia, occurs when part of the stomach has forced its way into the thoracic cavity. The diaphragm is the large muscle that separates the upper chest area (which contains the lungs and heart) from the lower abdominal cavity. The oesophagus penetrates the diaphragm muscle. It is possible for a portion of the stomach to slide upwards through this orifice. When this takes place there is usually a condition called oesophageal reflux present as well. This means that some of the acid contents of the stomach regurgitate back from the stomach into the lower part of the oesophagus. The symptoms are usually a combination of the hernia together with the presence of this acid material in the food pipe.
Hiatus hernia is an extremely popular diagnosis today. About 10 per cent of stomach x-rays indicate its presence.
Q. What symptoms does the person experience and how is it diagnosed?
A. A fairly intense burning sensation called heartburn or a tight pain in the midline just below the breast bone are common. It often radiates behind the breast bone into the throat and angles of the jaw. It has often been diagnosed as cardiac pain and at times the difference between the two is extremely hard to detect. It is possible the two conditions may co-exist. Burning acid material may run into the mouth (regurgitation). This is commoner if stooping or lying flat. It is also more common after a large meal, especially if much fluid has been taken. At night it is worse if a person sleeps on the left side. Rarely does it awaken a person from sleep.
Abdominal distention is common. A sensation of fullness, accompanied by belching, often occurs after a meal. Diagnosis is not possible apart from radiological examination. Symptoms discussed are frequent with ulcers and other gastrointestinal disorders. A visit to the doctor and maybe an x-ray investigation will clinch the diagnosis. When this has been made (and other possible causes excluded) treatment is often straightforward.
Q. What about treatment?
A. The doctor will probably set out a list of suggestions. These are quite straightforward and can be carried out simply at home. Hiatus hernia is a mechanical disorder. It is not an ulcer, it is not a cancer and it is not life-endangering. On the other hand it is seldom curative. But a sensible routine will often bring very good results and relief from the discomforting symptoms. Weight reduction. The disorder is common in older overweight women who have reproduced a family. Weight reduction is important and the general principles of a sensible reduced calorie diet should be commenced immediately. Commencing a routine of simple regular exercises will also help the latter as well as increase muscle tone and a sensation of general well being.
Q. I've often heard that the way you lie in bed is important. Also, that diet can play a significant part. Is this true?
A. Posture. Place bricks or wooden blocks under the head of the bed so that it is raised 6-8 in. during episodes of trouble and for one week after the symptoms subside. It is useless sleeping on pillows with the head and shoulders raised. The entire upper gastric tract must be elevated. This may be a little uncomfortable at first but one quickly adjusts and most partners do too! Avoid stooping after meals. Often pain comes on after food. Therefore, sit upright for 10-15 minutes rather than slump down in your favourite TV chair when symptoms will persist. Avoid prolonged stooping on all occasions.
Diet. Avoid large meals and avoid fluids with meals as this encourages 'reflux'. Soups, jellies and semi-solids, if desired, should be taken independently of the main meal. It is best to avoid gaseous fluids. Avoid foods which you know will produce discomfort. This will vary with the individual but spicy, highly seasoned, condiment-type ones may aggravate. Of course, it should go without saying, that cigarette smoking and the use of alcohol can only aggravate it. These are well known and potent acid stimulants and irritants and are best drastically reduced or preferably stopped.
Q. What about medication?
A. Probably the best are the alginic acid compounds (commercially known as Gaviscon). This reacts with the acid contents of the stomach forming a frothy gel which floats on top of the stomach contents, preventing it from refluxing or regurgitating into the oesophagus. It also neutralises out acids. If the material does flow into the oesophagus, it soothes and helps heal the inflamed lining. It comes as a liquid, granules or tablet. However, antacids in general are often useful as well and many different brands are readily available.
In severe cases, the histamine Preceptor antagonists, such as cimetidine, by cutting back acid production, will also bring a good deal of relief. Pain is caused by inflammation of the lining of the oesophagus so anything reducing this must help.
Q. Don't some cases finally require an operation?
A. About 10 per cent of patients may come to final surgery for a sliding hiatus hernia. If medical management has completely failed and if there are sinister complications, then surgery may be the final answer. However, it is a procedure of magnitude and not to be undertaken lightly. Young people often have a hasty desire to get rid of their symptoms and are often desirous of a surgical approach.
Long standing, severe cases may produce burning of the lower oesophagus, later on constriction and swallowing difficulties which may be a hazard. For this reason persisting symptoms should be actively treated.
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Gastrointestinal
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