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Ask Dr. K: Most hiatal hernias do not require treatment

DEAR DOCTOR K: My mother was recently diagnosed with a “sliding hernia.” What is this?

DEAR READER: A “sliding hernia” is a type of hiatal hernia. OK, so what’s a hiatal hernia? A hernia occurs when part of an organ juts through an opening into an area where it shouldn’t. The stomach is an organ that is supposed to stay in the abdomen, for example. The abdomen is separated from the chest by a flat, dish-like plate of muscle called the diaphragm.

Above the diaphragm are the lungs, heart and esophagus (the swallowing tube). Below are the stomach, intestines and other abdominal organs. The very bottom of the esophagus and the very top of the stomach are joined right at the diaphragm.

A hiatal hernia is named for the hiatus, an opening in the diaphragm. Food swallowed down the esophagus normally enters the stomach just below the diaphragm. In most people, that opening is small enough that the stomach could not fit through it.

In a hiatal hernia, however, the upper part of the stomach slips up through the diaphragm into the chest. The term “sliding” means that the junction between the stomach and esophagus moves up and down. Unlike the case in most people, the junction is not stuck right at the diaphragm. Sliding hiatal hernias are very common.

Many people with hiatal hernias have no symptoms at all. Hopefully, your mother is one of those. Others have heartburn or gastroesophageal reflux (GERD). This tends to be worse when they lean forward, strain or lie down. Still others may have a hard time swallowing, or chronic belching. Sliding hiatal hernias rarely cause major complications.

Most people with hiatal hernias do not require treatment. If your mother has reflux symptoms, lifestyle changes might help. For example, she can try eating smaller, more frequent meals. She should also avoid eating for at least two hours before going to bed and sit up for at least one hour after eating.

If lifestyle changes do not relieve her symptoms, medication can help. She can try one or more of the many antacids and acid blockers on the market.

Few people with a sliding hiatal hernia require surgery. Dr. Komaroff is a physician and professor at Harvard Medical School.

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