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Hiatal Hernia Syndrome

Updated: Sep 7, 2022

Hiatal hernia syndrome is one of the most common functional gastrointestinal disorders treated at Pacific Clinic of Natural Medicine. This syndrome occurs in the upper abdomen, where the esophagus and stomach meet through an opening (hiatus) in the diaphragm - the large muscle which separates your chest from your abdominal organs. HHS is distinguished by the fact that the stomach may cause upward pressure against the diaphragm. This is generally treatable with diet, exercises and manual adjusting of the stomach. A true hiatal hernia is a gastric pathology and occurs when part of the stomach protrudes through the opening of the diaphragm where the esophagus normally passes through, taking up space normally reserved for the heart and the lungs.

This functional disorder may be due to improper diet, increased intra-abdominal pressure or may be acquired from trauma. Eating foods that irritate the digestive system can make HHS more likely to develop and contribute to acid reflux by improper function of the lower esophageal sphincter. It is important to be evaluated for food intolerances since they do not necessarily produce an immediate, noticeable reaction. It exerts more of an accumulative effect that disrupts normal function and creates inflammation. HHS are most common in people that are overweight due to increased intra-abdominal pressure. An increase in intra-abdominal pressure may also be due to chronic coughing, vomiting, obesity, pregnancy or a mass of the abdomen. Examples of trauma include abdominal surgery, impact of jumping, and abdominal exercise.

The symptoms for HHS and hiatal hernia are the same, though can manifest differently for individuals. These include fatigue, fullness after small meals, shallow breathing, sensation of food or pills getting "stuck" in the throat, chest pressure, acid reflux, frequent burping, tickling cough, gas, bloating of the upper abdomen and even heart rhythm changes. In individuals with HHS, an upper endoscopy is often performed with normal findings and negative for inflammation in the esophagus or other complications.

The first step to treating this syndrome is dietary correction through avoidance of food intolerances. An in-office procedure can treat HHS with basic myofascial release of the diaphragm and visceral manipulation of the stomach. After treatment, the change should be immediate. Stomach tonics are also often prescribed to help support stomach function as well as exercises to strengthen the diaphragm. Dietary basics include avoiding overeating and large meals, taking the time to sit and chew food until it becomes liquid before swallowing. Also "how" you eat is just as important as "what" you eat, therefore avoiding stressful discussions or watching television while eating is also critical. A series of hydrotherapy treatments can also support healing of functional GI disorders by influencing circulation and improving nervous system and digestion function.

Home exercises are often prescribed after visceral manipulation of the stomach. Heel drops are performed on an empty stomach, first thing in the morning upon waking after drinking a glass of warm water. The downward momentum of the water-filled stomach helps maintain this correction and prevent reoccurrences of HHS.

Here's a recent case of a 32 year old male with chronic abdominal pain, GERD-like symptoms for about a year, with the worst recent episode following a work out. For the last 3-4 weeks he had been experiencing reflux within 20 minutes after eating. This all started around the time of increased stress due to a relationship. He lives a very active/healthy lifestyle. The general findings of this case included significant stress, strenuous abdominal exercise and ingestion of food intolerances contributing to chronic abdominal pain, acid reflux, nausea and hiatal hernia syndrome. His treatment plan focused on correcting digestive function through nutrients, herbs, removal of food intolerances and home exercises. At the follow up visit, we performed a hiatal hernia adjustment and hydrotherapy treatment. The patient reported significant improvement in GERD symptoms and abdominal pain. Since then he has been able to return to regular exercise routine without any issues.

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