Heartburn — it's been a part of your life for the last few years. When it first started it was very manageable with nonprescription antacids, but not lately. You wonder if it's time to seek help.
A number of factors can cause heartburn and other discomforts related to gastroesophageal reflux disease (GERD). One particularly frequent link is a hiatal hernia.
What causes a hernia
Your diaphragm — the large muscle separating your abdomen and chest — has an opening (hiatus) through which your food tube (esophagus) passes before connecting to your stomach.
When the upper part of the stomach pushes through the hiatus and into the chest cavity, this is known as a hiatal hernia or hiatus hernia. It's not always clear why this occurs.
Some people are born with a larger hiatus, making herniation more likely. Because the connective tissues at the hiatus are thought to stretch over time, your risk increases with age. Obesity increases your risk, as does persistent and intense pressure on the stomach muscle that can occur with coughing, straining during a bowel movement or physical exertion.
While these common hernias don't always lead to reflux symptoms, many people with reflux symptoms are found to have a hiatal hernia.
With most hiatal hernias, the area where the esophagus connects to the stomach (gastroesophageal junction) and the portion of the stomach immediately after it (cardia) are displaced above the diaphragm. This is known as a sliding or type 1 hiatal hernia.
Sliding hiatal hernias often...
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