September 16, 2011

Hiatal Hernia and GERD

Gastroesophageal reflux is the process whereby a small amount of the stomach contents flows back into the esophagus. Gastroesophageal reflux is commonly known as heartburn and is not unusual in humans. It is often brought on by the drinking of alcohol or the eating of certain foods that are fatty or spicy. Changes in posture such as lying down can also increase the occurrence.

Gastroesophageal reflux disease (GERD), on the other hand, occurs when a person experiences gastroesophageal reflux on a frequent basis. It is typically the direct result of a faulty sphincter in the lower portion of the esophagus, but there are many theories as to exactly what causes the incompetent sphincter. Although a faulty sphincter is thought to be responsible for the majority of GERD cases, other causes may include things such as systemic diseases like lupus, ingestion of corrosive materials, or extended intubation. The malfunction of this sphincter with its subsequent regurgitation results in a burning sensation in the region behind the sternum. Over time, this persistent reflux directly results in the inflammation of the esophageal lining which can eventually reach down to the muscular level. Once the inflammation penetrates into the muscular level, it causes muscle damage which further increases the amount and frequency of reflux that a person will experience. There is no one type of person who becomes afflicted with GERD. It is a very non-selective disease that occurs in the old and the young, the thin and the overweight, in both genders, and in all ethnicities. Because the disease is non-selective in who it affects, the diagnosis is often difficult and tends to rely on patient history, x-ray studies, and endoscopy of the esophagus. Diagnosis of GERD can often be tricky as it can mimic other disease processes such hiatal hernia.

Hiatal hernia can mimic GERD, but it is a completely different condition. The cause is not known, but it can occur as a result of trauma or it can be congenital. Basically, a hiatal hernia is the protrusion of a portion of the stomach through the diaphragm opening. It can be an ongoing occurrence or an infrequent one. When it is of the ongoing variety, it is known as a rolling para-esophageal hernia. This variety has a low incidence and tends to account for approximately ten percent of all cases of hiatal hernia. The more common form of hiatal hernia is the sporadic type which is known as a sliding hernia. This type accounts for approximately ninety percent of all hiatal hernias and tends to happen in response to changes in position. Essentially what happens is that the stomach protrudes through the diaphragm’s opening when a recumbent (lying down) position occurs. When a more upright position is achieved, the stomach slides back to its normal position. Many people who have both types of this hernia are asymptomatic, but others exhibit signs of gastroesophageal reflux especially when lying down. When reflux occurs, it is considered to be of concern and treatment is usually recommended.

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