hiatal

A hiatal hernia is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. Your diaphragm is the thin muscle that separates your chest from your abdomen. Your diaphragm helps keep acid from coming up into your esophagus. When you have a hiatal hernia, it's easier for the acid to come up. This leaking of acid from your stomach into your esophagus is called GERD (gastroesophageal reflux disease). GERD may cause symptoms such as :

• Heartburn
• Problems swallowing
• A dry cough
• Bad breath
• Nausea and/or vomiting
• Breathing problems
• The wearing away of your teeth

Often, the cause of a hiatal hernia is unknown. It may have to do with weakness in the surrounding muscles. Sometimes the cause is an injury or a birth defect. Your risk of getting a hiatal hernia goes up as you age; they are common in people over age 50. You are also at higher risk if you have obesity or smoke.

People usually find out that they have a hiatal hernia when they are getting tests for GERD, heartburn, chest pain, or abdominal pain. The tests may be a chest x-ray, an x-ray with a barium swallow, or an upper endoscopy.

You don't need treatment if your hiatal hernia does not cause any symptoms or problems. If you do have symptoms, some lifestyle changes may help. They include eating small meals, avoiding certain foods, not smoking or drinking alcohol, and losing weight. Your health care provider may recommend antacids or other medicines. If these don't help, you may need surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Sometimes, after eating a large meal or lying down too soon after eating, you might feel acid coming up into your throat. This is called gastroesophageal reflux (GER). It happens when the muscle at the end of your esophagus (the tube that carries food from your mouth to your stomach) doesn't close properly. Stomach contents can then move back up and irritate the esophagus.

Having reflux occasionally is common. But if you have symptoms two or more times a week or if they cause damage to the lining of your esophagus, you may have gastroesophageal reflux disease (GERD). GERD is a chronic (long-lasting) condition that can cause discomfort and, over time, lead to other health problems.

Anyone can have GERD, including infants and children.

GERD can happen when the muscle at the bottom of your esophagus becomes weak or relaxes at the wrong time. You are more likely to have GERD if you:

• Are overweight or have obesity
• Are pregnant
• Smoke or are around secondhand smoke
• Have a hiatal hernia (when part of the stomach pushes up into the chest)

Certain foods, drinks, or medicines can also make GERD worse.

The most common symptom of GERD is heartburn. This is a burning feeling in your chest or throat. You can also have GERD without having heartburn. Other symptoms may include:

• Tasting acid or food in the back of your mouth
• A dry cough or hoarse voice
• Asthma-like symptoms
• Trouble swallowing

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These can be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may recommend tests such as:

• Upper GI endoscopy to look at the esophagus and stomach lining with a tiny camera.
• Biopsy to check a small tissue sample.
• X-Ray to take pictures of the upper digestive system.
• Esophageal pH test to measure how often acid backs up the esophagus and how long the acid stays there.
• Esophageal manometry to check how well your esophagus moves food when you swallow.
• Transnasal esophagoscopy to look for damage to the esophagus by using a small tube with a camera.

Most people can manage GERD with lifestyle changes and medicine. In rare cases, surgery is needed.

Lifestyle changes can include:

• Eating smaller meals and avoiding lying down for at least 2-3 hours after eating
• Avoiding foods that trigger symptoms, such as spicy foods, chocolate, caffeine, or fatty foods
• Losing weight if needed
• Raising the head of your bed
• Quitting smoking

Medicines can include:

• Over-the-counter medicines, such as antacids
• Prescription medicines

If not treated, GERD can cause problems like inflammation of the esophagus, scarring, or changes in the tissue lining (Barrett's esophagus). It can also worsen asthma or cause chronic (long-term) cough or hoarseness.

You may be able to improve symptoms of GERD by:

• Avoiding alcohol and trigger foods
• Eating smaller meals
• Not eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A hernia happens when part of an internal organ or tissue bulges through a weak area of muscle. Most hernias are in the abdomen.

There are several types of hernias, including:

• Inguinal, in the groin. This is the the most common type.
• Umbilical, around the belly button
• Incisional, through a scar
• Hiatal, a small opening in the diaphragm that allows the upper part of the stomach to move up into the chest.
• Congenital diaphragmatic, a birth defect that needs surgery

Hernias are common. They can affect men, women, and children. A combination of muscle weakness and straining, such as with heavy lifting, might contribute. Some people are born with weak abdominal muscles and may be more likely to get a hernia.

Treatment is usually surgery to repair the opening in the muscle wall. Untreated hernias can cause pain and health problems.

Gastroesophageal reflux (GER), often called reflux, occurs when food or stomach acid flows back from your child's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. This can sometimes cause irritation or a burning sensation. Occasional reflux is common and usually not a problem.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. GERD can cause repeated symptoms or damage to the lining of the esophagus. Having reflux two or more times a week may be a sign of GERD. Your child's health care provider may diagnose GERD if the reflux causes pain, feeding problems, or irritation of the esophagus.

A small muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach. When your child swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents and acid don't flow back into the esophagus. This muscle, along with the diaphragm (the large muscle between the chest and abdomen), usually prevents reflux. It's normal for children to have reflux occasionally.

In children who have GERD, the lower esophageal sphincter may be weak or relax when it shouldn't. That allows stomach contents into the esophagus. This can happen because of:

• A hiatal hernia, a condition in which the upper part of the stomach pushes up into the chest
• Increased pressure on the abdomen (belly) from being overweight or having obesity
• Certain medicines, such as some used to treat asthma, allergies, depression, or pain
• Smoking or exposure to secondhand smoke
• Previous surgery on the esophagus or upper abdomen
• Developmental delays or certain neurological conditions, such as cerebral palsy
• Lung conditions, such as cystic fibrosis

Many children have occasional reflux, especially after large meals or physical activity. GERD is less common, and most symptoms improve with time and lifestyle changes.

Symptoms may vary by age. Some children might not even notice reflux, while others may taste food or stomach acid in the back of their mouth.

In children, GERD can cause:

• Heartburn, a burning feeling in the chest or throat (more common in older children and teens)
• Bad breath
• Nausea or vomiting
• Trouble or pain when swallowing
• Cough, hoarseness, or breathing problems
• Wearing away of tooth enamel from stomach acid

Other conditions can cause similar symptoms. Talk to your child's provider if symptoms happen often or make eating, sleeping, or daily activities difficult.

In most cases, your child's provider can tell if it's reflux by learning about your child's symptoms and health history. Tests are usually needed only if symptoms don't get better with lifestyle changes or medicines, or if another health problem is suspected.

Common tests include:

• Upper GI series, which looks at the shape of your child's upper GI (gastrointestinal) tract. Your child will drink or eat a chalky-tasting liquid called barium. For young children, the barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your child's esophagus and stomach.
• Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child's esophagus. A thin flexible tube is placed through their nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your child will wear the tube for 24 hours. They may need to stay in the hospital during the test.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. An endoscope is inserted down your child's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

Simple lifestyle changes can often improve symptoms. Examples include:

• Maintaining a healthy weight.
• Eating smaller meals.
• Avoiding high-fat foods or other trigger foods that cause symptoms.
• Wearing loose-fitting clothing around the abdomen (belly).
• Staying upright for 3 hours after meals and avoiding slouching when sitting.
• Sleeping with the head of the bed raised 6 to 8 inches.

If lifestyle changes aren't enough, your provider may recommend medicine to reduce stomach acid. The medicines work by lowering the amount of acid your child's stomach makes. Some are available over-the-counter, while others need a prescription. Do not give your child any medicine unless your provider recommends it.

If symptoms don't get better or are severe, your provider may refer you to a doctor who treats stomach and digestion problems in children. In rare cases, surgery may be considered.

If GERD isn't treated, it can cause problems such as inflammation or scarring in the esophagus, changes in its lining (Barrett's esophagus), or make breathing problems, like asthma, worse.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Gastroesophageal reflux (GER), often called reflux or spitting up, happens when food or milk comes back up from your baby's stomach into the esophagus. The esophagus is the tube that carries food from your mouth to your stomach. Reflux is very common in healthy babies. It usually starts to get better by 6 months of age and goes away by 12 months. Reflux that continues after 18 months is unusual.

Gastroesophageal reflux disease (GERD) is a more serious and long-lasting type of reflux. It can cause feeding problems, discomfort, or other symptoms that affect your baby's growth or sleep. Babies may have GERD if symptoms prevent them from feeding well or last longer than 12 to 14 months.

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, this muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). As your baby grows and the sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't. This allows stomach contents to come up more often or cause irritation.

Reflux is very common in babies and usually goes away on its own. Most babies spit up several times a day during their first 3 months. They usually stop spitting up between the ages of 12 and 14 months.

GERD is less common. Babies may show symptoms, but they decrease with growth, with only a small number of babies affected by 12 months.

Babies are more likely to have reflux or GERD if they:

• Were born too early (premature)
• Have lung problems, such as cystic fibrosis
• Have conditions that affect the nervous system, such as cerebral palsy
• Have a hiatal hernia (when part of the stomach pushes up into the chest)
• Have had surgery on the esophagus

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as:

• Arching of the back, often during or right after eating
• Coughing
• Gagging or trouble swallowing
• Irritability or crying, especially after eating
• Poor eating or refusing to eat
• Not gaining enough weight or losing weight
• Wheezing or trouble breathing
• Forceful or frequent vomiting

Other conditions can cause similar symptoms. Contact your baby's health care provider if your baby has symptoms, especially if your baby isn't gaining weight.

In most cases, your provider diagnoses reflux by reviewing your baby's symptoms and medical history. Testing is only needed if symptoms don't get better with feeding changes or medicines, or if there are other health concerns.

Several tests can help your provider diagnose GERD. Sometimes more than one test may be ordered to get a diagnosis. Common tests include:

• Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a chalky-tasting liquid called barium. The barium is mixed in with a bottle or other food. Several x-rays are taken to track the barium as it goes through your baby's esophagus and stomach.
• Esophageal pH or impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A thin flexible tube is placed through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
• Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. An endoscope is inserted down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, tissue samples (biopsy) may be taken.

Simple feeding changes may help reduce your baby's reflux:

• Add rice cereal to your baby's bottle of formula or breastmilk. Check with your provider about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
• Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
• Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
• Hold your baby upright for 30 minutes after feedings.
• If you use formula and your provider thinks that your baby may be sensitive to milk protein, they may suggest switching to a different type of formula. Do not change formulas without talking to your provider.

If feeding changes do not help enough, your provider may recommend medicines to reduce stomach acid. Medicines aren't usually needed, and are only suggested if your baby still has regular GERD symptoms and:

• You have already tried some feeding changes
• Your baby has problems sleeping or feeding
• Your baby does not grow or gain weight properly

Acid-blocking medicines may be given for a short time to see if they help. You shouldn't give your baby any medicines unless your provider tells you to.

If medicines don't help and your baby still has severe symptoms, your provider might talk to you about surgery. Surgery is rarely needed for babies with GERD. It may be considered only if reflux causes serious breathing problems or if your baby isn't gaining enough weight.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases