Dear Dr. Johnson: What is the difference between heartburn and hiatal hernia?
Hiatal hernia refers to an anatomical condition in which the opening of the diaphragm through which the foodpipe passes is ``loose,`` allowing the stomach to slide up into the chest cavity. This condition becomes very common as we grow older and can be diagnosed with appropriate X-rays in many individuals--even if they have no symptoms or complaints.
Heartburn, on the other hand, is a symptom that results when gastric juices (stomach acid) back up into the lower end of the foodpipe, irritating the lining. The technical name for this condition is reflux (backing up)
esophagitis (inflammation of the esophagus or foodpipe).
The important point is that there is no automatic correlation between the anatomical problem known as hiatal hernia and the physiological condition known as reflux esophagitis. A person may have one without the other.
When heartburn exists, it usually is treated first with mechanical maneuvers--avoiding pressure on the stomach area and avoiding positions that aid gravity in the backflow of stomach juices. Sleeping with 4- to 6-inch blocks under the head of the bed is one of the most successful ways to avoid heartburn during the night. Lying down after a big meal, avoiding tight fitting garments, losing weight and avoiding large meals all are measures designed to decrease the mechanical backflow of stomach contents.
It is also usually helpful to avoid foods, liquids or other substances known to decrease the pressure barrier between the foodpipe and the stomach. These include chocolate, peppermint, alcohol, nicotine, etc. Otherwise, certain drugs can help increase the pressure barrier between the foodpipe and the stomach. Drugs that decrease acid secretion or that counteract acids
--antacids--also can be useful.
Surgery is a treatment of last resort in ``tightening`` the area around the lower end of the foodpipe. Today almost all individuals with heartburn, even severe cases of heartburn, can be helped without surgery. And once again I stress that just because a person has a hiatal hernia doesn`t mean it must be surgically corrected. The hernia may have nothing to do with the heartburn.