Indigestion or a hiatal hernia?

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Bad breath after moving house? Heartburn from classes in a fitness club? It is possible. If you overdo it, some of your esophagus or stomach may move. And then symptoms appear which, even though they pretend to be common ailments, mean more serious problems.

Marta had an unpleasant belching and heartburn for the first time at the beginning of her pregnancy, but doctors reassured her that it was normal. More and more kilos were added, and everything she ate was coming to her throat. She gave birth, but the ailment did not disappear. While still in the hospital, she caught an infection, and because she was not able to use all the drugs, the cough tired her for weeks. When it finally passed, my heartburn returned. This time she heard from the doctor that it was not normal. He recommended gastroscopy.

Before the holidays, Michał decided to work on his figure, which lost some of its attractiveness in winter. He focused on intensive training in the gym: barbells, dumbbells and other heavy weight aids were in motion. After a month, he noticed that almost every time he lay down on the bench he felt acid in his esophagus. In addition, this unpleasant breath, which could not be masked by anything. He put down the energy drinks because it was the worst after them. But it didn’t help. As in the case of Martha, the doctor recommended a gastroscopy. The diagnosis was the same: hernia.

The digestive system is constantly in motion to keep the food moving. But if part of it is moved permanently, for example after exercise, ailments arise that may “pretend” to be common indigestion. Indigestion symptoms are usually the digestive system’s reaction to our eating sins. But there are unpleasant ailments with proper nutrition. When this happens, you should look for the cause. One of them may be a hiatal hernia.

What is that?

This is a weakening or stretching of the hiatus – the opening in the diaphragm through which the esophagus passes from the chest to the abdomen. The diaphragm is a broad and relatively thin muscle stretched between the lower ribs, separating the chest from the abdominal cavity. In addition, the diaphragm is involved in the chest breathing movements, it also moves when talking and singing. When the hiatus of the diaphragm stretches and no longer tightly covers the end of the esophagus, gastric acid reflux into the esophagus, causing irritation and inflammation of the lining of the esophagus. If the hiatus is significantly dilated, part of the stomach may move to the chest, which prevents food from moving properly towards the intestine. There may be various causes of the disease. The most frequently mentioned are the increase in pressure in the abdominal cavity when lifting heavy objects, accompanying severe abdominal injuries, during prolonged, persistent coughing and sneezing, constipation, as well as during pregnancy and childbirth. Obese people, smokers, and people living under constant stress are more at risk of developing a hernia. A hernia can also be congenital.

What should arouse suspicion?

Sliding hernias are often asymptomatic. However, they can contribute to the formation of gastroesophageal reflux. Symptoms of reflux most often appear within an hour after a meal:

– pain and burning or squeezing in the upper abdomen and sternum (because pain occurs in the area of ​​the heart is often, especially in the elderly, confused with symptoms of ischemic heart disease or even myocardial infarction)

– heartburn and belching

– bitterness or acid in the mouth

– pouring food

– hoarseness, cough

– unpleasant smell from the mouth

– difficulty swallowing (less common)

Important. Particular attention should be paid to the feeling of food “stagnating” in the esophagus behind the sternum, as it may be the first symptom of esophageal cancer, as well as burning behind the sternum accompanied by shortness of breath, nausea or sweating – due to the necessity to rule out a heart attack. You should also seek medical help in the event of severe vomiting, as well as vomiting blood. The persistence of disease symptoms after a month of treatment is also an indication for medical re-examination.

You can’t move without gastroscopy

To exclude other diseases that are characterized by similar symptoms, gastroscopy or X-ray examination with contrast is necessary. Thanks to them, we can also recognize the type and size of the hernia. Performing gastroscopy raises a lot of emotions and causes unnecessary stress. Modern gastroscopes are thin flexible tubes that allow you to carefully examine the upper part of the gastrointestinal tract on the monitor and, if necessary, take samples for examination. The examination usually takes up to 5 minutes. In addition to gastroscopy, other tests may be necessary to rule out other similar diseases.

What after diagnosis?

The most important thing is to alleviate unpleasant symptoms and prevent complications. Treatment always begins with non-operative methods.

Changing your lifestyle is helpful, including:

– diet modification: avoiding heavy meals. Eat small but frequent meals. Preferably 5-6 a day. You have to eliminate hard-to-digest and bloating products, such as cruciferous plants, legumes, and fried foods;

– raising the entire bed from the head by 10-15 cm, thanks to which the stomach will stay below the hernia opening at night;

– quitting smoking;

– no need to wear tight tights, underwear and belts;

– avoiding overexertion while urinating, stools and lifting heavy objects, and treating constipation;

– eat the last meal no later than two hours before bedtime. Meals should not be eaten in a hurry;

– shedding excess weight (in obese people, weight normalization often leads to complete relief of symptoms);

– avoiding alcoholic and caffeinated drinks (coffee, tea, cocoa, coca-cola), as well as those dishes and spices that aggravate symptoms;

– do not lie down or bend over immediately after a meal.

There are no restrictions on physical activity. On the contrary, it is indicated to improve the functioning of the digestive system. It is worth supporting a balanced diet and physical activity with appropriate supplementation. At Medonet Market, you can now buy turmeric extract, which has anti-inflammatory and immune-boosting properties.

Drug treatment is also important:

– medicines to neutralize or suppress gastric acid secretion (some people find improvement in taking them about 1 hour before eating and before going to bed, while others help when taken 1-2 hours after meals and at bedtime. medication regimens and use the one that is more effective)

– drugs that accelerate peristalsis (the passage of food from the esophagus into the stomach and duodenum)

– drugs to prevent constipation

In advanced disease, surgical procedures are performed.

Surgery is sometimes necessary

It is only necessary in cases where changing the lifestyle and administering drugs does not bring improvement or complications arise. Then, procedures are performed consisting in strengthening the muscle ring surrounding the esophageal hiatus of the diaphragm or in such a fixation of the stomach in the abdominal cavity to prevent its contents from flowing back into the esophagus. Most often, the procedure is performed using the laparoscopic method. In cases of many years of oesophagitis accompanying an untreated hiatal hernia, a malignant tumor may develop.

Consultation: Antoni Gugulski, MD, PhD, gastroenterologist, specialist in XNUMXnd degree internal medicine and family medicine (www.gugulski.med.pl)