Homeopathy 

Hiatus hernia

Hiatus hernia medically means the herniation/popping of stomach into the chest through a hole in the diaphragm. The abdomen contents are entirely covered and separated completely from the chest by this thick tense muscular fibrous sheath – the diaphragm. It allows food tube to communicate with the stomach and blood vessels to communicate with the lower parts through appropriate tight openings. None other can slip into the chest in normal condition, since openings tightly hold the food tube or vessels.

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However, when diaphragm gets weakened or if intra abdominal pressure dominates, hiatus hernia can occur. In the case of hiatus hernia, the stomach as such starts getting into the chest following the food tube or in another way. More than the pressure symptoms in chest due to the bulge or symptoms of stomach that herniates, the more one suffers due to hiatus hernia is the food tube - the oesophagus.

Nature had created each and everything with a special character in our human body. The natural architecture of the human food tube is one such. The food tube can propel food into the stomach even in the upside down position. In the same manner, non-return valve at the junction of the lower end of the food tube and upper (cardiac) end of stomach will not allow even water in the reverse direction even if the stomach is full. The natural architecture that prevents back flow of food is by the following mechanisms:

• Oesophagus enters (ends in) stomach in an oblique manner. This oblique joining/ junction enhances the tight closure of valve while the stomach gets distended or filled up.

• Stomach lies in the abdomen i.e., completely below the diaphragm. The one-way valve also lies below the diaphragm. So, the high intra-abdominal pressure will also influence this valve for tight closure to avoid back flow.

Usually, hiatus hernia lets the food tube valve go above the diaphragm. Thus losing natural controls, the valve ends in relaxation and permission of food and acid contents from stomach into the lower end of the food tube. This ends further in ulceration and causing burning volcano in the chest – heart burn. These symptoms often mimic symptoms of heart problems. So, hiatus hernia keeps patients constantly annoyed with the suspicion of heart trouble.

Types - Hiatus hernia usually arises in two types. They are

• Sliding hernia – is the most common type of hiatus hernia. It is the herniation of stomach in a sliding manner into the chest, i.e., it just slips up into the chest following the food tube. It can occur while lifting weight, straining, bending or lying down.

• Bulging or rolling hernia – is bulging of stomach through a weak point of diaphragm. 

Incidences and causes – Hiatus hernias are reward of strain or injury or increased abdominal pressure. Overeating, overstraining, overweight, overtightening may cause hiatus hernia. Strained defecation, strained urination, strained cough, strained vomiting, etc., can also cause hiatus hernia.

Hiatus hernias are more common in adults and rare in children. Females after the age of menopause have usually higher incidences. The diaphragm will get weakened with age, constant increased intra abdominal pressure, overeating, multiple pregnancy, etc. Irrespective of sex, obese and aged persons with the habit of smoking and drinking alcohol will suffer more from hiatus hernia. Sometimes, congenital short oesophagus can also cause sliding hiatus hernia.

Symptoms – Usually hiatus hernia will not produce any symptoms in the initial stages. However, it can cause discomfort in the chest and stomach as hernia increases in size. The major symptoms are

• Ball like sensation or chest oppression after meal.

• Sometimes ball like sensation seems to be raising in chest (due to crawling food tube)

• Burning pain behind the breast bone (retro sternum pain) with sour eructations

• Belching often with chest discomfort

• Difficulty in swallowing and even a small hand full meal seems to fill the abdomen

• Indigestion, nausea and vomiting (of food/occasionally blood)

• Anaemia and weight loss when left untreated for a prolonged time

• Complaint usually aggravated or triggered by lying down and bending.

Diagnosis - Hiatus hernia can be easily identified with its symptoms of aggravation following a heavy meal. Anyway, detailed evaluation by a gastroenterologist is required to reveal the condition clearly and to proceed for apt treatment. Following tests will give a clear idea about hiatus hernia and its intensity.

• Barium meal X-ray series – to confirm hiatus hernia and its nature of swelling. Also it can rule out obstruction/strictures, if any.

• Endoscopy tests to confirm oesophagus ulcerations and hiatus hernia 
  Biopsy of the ulcers (if any) - to rule out cancer or presence of H. pylori

• Ultrasound abdomen scan - to rule out other organ involvement (gall bladder and pancreas, liver, etc)

• MRI – helps in difficult cases to get diagnosed

• Finally, it is not out of place to rule out heart involvement by checking BP and ECG

Complications – The repeated acid reflux due to regurgitation in case of hiatus hernia will often cause recurrent ulcerations in lower end of oesophagus. These ulcers often bleed continuously in small quantity to cause anaemia. Also constant ulcer intends to raise the risk of cancer. Even then, these ulcers heal; they heal with scar which narrows the oesophagus to cause difficulty in swallowing. Weight loss results finally due to reduced intake and anaemia.

Management

DO 

• Try to lose weight as first line of management in case of hiatus hernia.

• Have meals slowly in a relaxed manner, without any hurry or tension

• Stand or sit erect after eating

• Sleep in 45 degree elevated bed or keep high pillows while sleeping

• Go for a relaxed walk after diet

TAKE

• Easily digestible and oil free diet to reduce the work load of stomach 
  Plenty of juices

• Meal never more than 3/4th of the stomach

• Small meal often to neutralise the acid load in the stomach to avoid acid reflux

AVOID

• Tight waist belt 

• Stooping, bending, lying down, lifting weights and doing exercise upside down

• Habits of smoking, drinking and chewing tobacco

• Food containing high spices, chilies, pepper, and sausages

• Aerated drinks, coffee and tea

• Overeating/full meal, oily food, pickles and fatty snacks before bed time

• Drugs like NSAIDs / pain-killers / birth control pills / nitrates

General treatment for heartburn – Hiatus hernia as such produces only pressure symptoms or discomfort feeling whereas recurrent acid reflux causes oesophagitis, oesophageal bleeding, strictures and obstruction in lower end of oesophagus. So to avoid / arrest this acid reflux, most of the patients are prescribed only antacids or H2 blockers as management or treatment with habit and diet recommendations. 

Surgery - In resistant and very painful cases, surgery is advised as a last resort to remove ulcerated / sclerosed / constricted oesophagus and to repair diaphragm to correct hiatus hernia. This surgical procedure will improve dietary intake immediately. Advanced laparoscopic surgery can answer this hiatus hernia in an easier way.

Homeopathic approach to acidity - Without putting off the fire, covering the fire is like adding fuel to it for a dangerous event. Managing hiatus hernia only with antacids and without any stress and strain limitation will lead one straightaway to the surgeon’s table. So, habit alternation and dietary changes should be followed strictly to manage hiatus hernia whatever the medicine or system followed.

Hiatus hernia need not be operated upon if it is in the initial stages, as it can be easily managed with Homeopathic medicines. Even though scientific evidence won’t prove reduction in size of hiatus hernia, hiatus hernia can be managed with Homeopathic medicines with respect to symptoms. Homeopathy gives importance to patient symptoms rather than disease symptoms. It also gives importance to patient's sensations like ball / raising ball-like sensation in the chest, block in the chest, gurgling and rolling of wind, relief from belching / flatus or not, difficulty in bringing up wind, appetite, nausea, cravings, aversions, aggravating factors, ameliorating factors, etc. As cure is impossible hiatus hernia can be managed well symptomatically by the use of Homeopathic medicines.

In severe cases, where most of the stomach enters the chest, there is need for surgery. Sometimes even after surgery, feeling of discomfort, chest tightness may continue to persists due to repair done to the diaphragm. Also one should be aware that even after surgery one has to restrict strain as before. So, it is better to adopt strain restriction, habit alternation and dietary changes in the start-up stage itself, to manage the complaints without the surgeon’s knife.

Homeopathic medicines commonly used in cases of hiatus hernia are Acid nit, Ambra G, Antim crud, Arg Nit, Ars alb, Asafoetida, Baptisia, Borax, Bryonia, Capsicum, Carbo veg, Causticum, China, Cocculus, Colocynth, Condurango, Hydrastis, Ignatia, Ipecac, Iris vers, Kali bich, Lycopodium, Nat mur, Nat phos, Nux Vom, Phosphorus, Pulsatilla, Rhus tox, Robinia, Silicea, Sulphur, Symphytum, etc. These medicines should be taken under the advice and diagnosis of a qualified Homeopath.

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Published on April 10^th, 2006