What is Heartburn?
Heartburn is the feeling of burning sensation in the upper abdomen or the central chest. This happens when the stomach acid enters the esophagus (foodpipe in the chest). This can happen when the muscle at the junction of esophagus and the stomach gets weaker and hence is unable to prevent the reverse flow of food and acid from the stomach to the esophagus.
Occasional heartburn isn’t dangerous, but chronic heartburn or gastroesophageal reflux disease (GERD) can sometimes lead to serious problems.
What causes Heartburn?
Two excesses often contribute to this problem: too much food in the stomach (overeating) or too much pressure on the stomach (frequently from obesity, pregnancy, or constipation).
Certain foods such as tomatoes, citrus fruits, garlic, onions, chocolate, coffee and peppermint can also cause it. Meals high in fats and oils (animal or vegetable) often lead to heartburn, as do certain medications.
Stress and lack of sleep can increase acid production and can cause heartburn.
Addictions such as smoking and alcohol are major contributors.
The correctable medical problem that can be responsible is Hiatus Hernia.
What is a Hiatus hernia?
In a hiatus hernia, a part of the stomach that should normally be in the abdomen protrudes through the diaphragm into the chest (See picture). This hernia allows food and acid abnormally to travel upwards and may produce symptoms.
What are the symptoms in Hiatus hernia?
These individuals experience heartburn when acid produced in stomach enters the chest. They also experience the distressful symptom of regurgitation (feeling of food coming up in the throat) when food travels into the chest due to this wide defect. Some hiatus hernias can lead to dysphagia (difficulty in swallowing) too.
What causes a Hiatal Hernia?
Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, coughing, or straining during bowel movements may also play a role. Being overweight and obese is a definite risk factor for hiatus hernia.
How is a Hiatal Hernia Diagnosed?
A hiatal hernia can be diagnosed with a specialized X-ray (using a barium swallow or with endoscopy.
What is the first-line treatment of Hiatus Hernia and GERD (heartburns)?
Most heartburns with or without hiatus hernia can be controlled by dietary changes and medicines. Surgery is required if these measures fail.
When Is Hiatal Hernia Surgery Necessary?
Hiatus hernia surgery is needed if symptoms of GERD and regurgitation cannot be controlled effectively by medicines. Also, if the hiatal hernia (in the paraesophageal variety) is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.
Hiatal hernia surgery can nowadays be performed as a laparoscopic procedure. The advantages of laparoscopic surgery include smaller incisions, less pain, a one day hospital stay and a more rapid recovery.