Overview of Hiatal Hernia & Reflux

The esophagus is a muscular tube that runs from the back of the throat to the stomach and propels swallowed food to the stomach for digestion. The junction, or valve, between the esophagus and stomach is called the gastroesophageal junction, or GE junction.

When functioning properly, the GE junction is a one-way valve. It is important that food goes through the esophagus into the stomach, but not from the stomach back into the esophagus. The problem with the stomach to esophagus route is that the material in the stomach is acidic, and acid is very irritating and destructive to the lining of the esophagus.

The stomach is located just beneath the left hemidiaphragm, the thin dome-shaped layer of muscles that divides the chest cavity from its abdominal counterpart, the peritoneal space. The atmosphere is quite different in the two places. Because the lungs must have the ability to expand, the chest cavity requires a negative pressure, while in the abdomen, normal pressure is fine. The diaphragm is more than just a barrier; because it is a muscle, it also acts like a bellows. During a deep breath in (inspiration), the hemidiaphragm goes down, expanding the chest and lungs for maximal inspiration of air and oxygen. When the diaphragm goes up, the chest and lungs contract and air is forced out of the small sacs in the lungs at maximal expiration. The organs in the abdomen also respond to this motion to some extent.

Although the organs of the chest are separate from the organs of the abdomen, several important structures need to go from one region to the other, such as the main blood vessels (aorta and vena cava) and the esophagus. There are several openings in the diaphragm that permit these structures to enter. These structures have a "seal" made up of thin fibrous tissue, which is called a hiatus. One such hiatus allows the esophagus to connection between the mouth and the stomach.

As some people age, the top of the stomach tends to begin to protrude through the esophageal hiatus into the chest. When this happens and since the GE junction is no longer where it is supposed to be, the valve may lose its ability to act as a one-way valve and acid material in the stomach is now able to pass into the esophagus. This condition is called reflux and it often causes trouble.

Reflux of acid may cause significant inflammation to the esophageal lining, a situation that can be very uncomfortable and even painful. Chronic reflux also is associated with esophageal cancer. The esophagus may become so inflamed and spastic that becomes difficult for food to be propelled into the stomach.

In most cases, these small hernias through the hiatuses, which are called hiatal hernias, cause only mild symptoms. Conservative treatment usually is sufficient. Certain types of hiatal hernias may require surgery.

Because acid in the stomach causes the damage, treatment may involve taking medication to diminish acid production. Antacids may be helpful, as may be remaining upright after eating. It also is sometimes helpful to walk around slowly for awhile and let the food pass into the stomach. Eliminating or decreasing caffeine and alcohol intake can also help.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 30 Apr 2000

Last Modified: 21 Sep 2015