A hiatal hernia, where a portion of the stomach moves into the chest cavity, and anemia, characterized by a reduced number of healthy red blood cells, are distinct health conditions. However, a connection exists between them, particularly regarding iron-deficiency anemia. This article explores how a hiatal hernia can contribute to anemia.
Understanding Hiatal Hernias
A hiatal hernia occurs when the upper part of the stomach pushes into the chest through an opening in the diaphragm, the muscular wall separating the abdomen from the chest. This opening, known as the hiatus, normally allows the esophagus to connect with the stomach.
There are two main types. A sliding hiatal hernia, the most common, involves the junction between the esophagus and stomach, along with part of the stomach, intermittently sliding into the chest. A paraesophageal hernia, less common but potentially more serious, occurs when a portion of the stomach pushes into the chest alongside the esophagus, with the gastroesophageal junction remaining in its normal position. Many individuals with a hiatal hernia experience no symptoms, but others may have heartburn, regurgitation, chest pain, or difficulty swallowing.
The Connection: How Hiatal Hernia Can Cause Anemia
A hiatal hernia can lead to anemia, most commonly iron-deficiency anemia, primarily through chronic, subtle blood loss. This mechanism involves irritation and microscopic bleeding from the stomach lining that has herniated into the chest cavity. This persistent, often unnoticed, blood loss gradually depletes the body’s iron stores over time. Iron is a component of hemoglobin, the protein in red blood cells that carries oxygen, so a lack of iron impairs the body’s ability to produce enough healthy red blood cells.
A specific type of lesion, known as Cameron lesions, can form at the neck or “waist” of the hernia where the stomach rubs against the diaphragm. These linear erosions or ulcers are a frequent source of the chronic occult bleeding that contributes to iron deficiency. The mechanical stress from the stomach’s movement through the diaphragmatic opening can cause these mucosal injuries.
In some cases, the abnormal positioning of the stomach within the hernia can also affect stomach acid production. Adequate stomach acid is important for the absorption of dietary iron. Impaired acid production can hinder the body’s ability to absorb iron from food, compounding the iron deficiency caused by blood loss. This combination of chronic bleeding and potential malabsorption explains how a hiatal hernia can directly contribute to iron-deficiency anemia.
Recognizing Symptoms and Getting a Diagnosis
When a hiatal hernia leads to anemia, the symptoms are those of iron-deficiency anemia, which often develop gradually. Individuals might experience:
Persistent fatigue and weakness
Pale skin
Shortness of breath
Dizziness
Cold hands and feet
Irregular heartbeat
These signs may initially be subtle, making the condition challenging to identify without medical evaluation.
Diagnosing a hiatal hernia typically involves imaging studies like a barium swallow, which allows doctors to visualize the stomach’s position, or an endoscopy, where a flexible tube with a camera is inserted to examine the esophagus and stomach directly. To diagnose anemia, blood tests are performed, including a complete blood count (CBC) to measure red blood cell levels and iron studies to assess the body’s iron stores, such as ferritin and transferrin saturation. When anemia is suspected in someone with a hiatal hernia, healthcare providers consider both conditions together to determine if the hernia is the underlying cause of the iron deficiency.
Treatment and When to See a Doctor
Managing anemia caused by a hiatal hernia involves addressing both the iron deficiency and the hernia itself. Iron supplementation, either oral or intravenous, is a common approach to restore the body’s iron levels and improve red blood cell count. Acid-reducing medications, such as proton pump inhibitors, may also be prescribed to help heal any mucosal erosions within the herniated stomach and reduce further blood loss. Lifestyle adjustments, like dietary changes or weight management, can also help manage hiatal hernia symptoms.
In some situations, if conservative treatments do not resolve the anemia or if the hiatal hernia is large and causing significant complications, surgical intervention may be considered. Surgery aims to reposition the stomach into the abdomen and repair the opening in the diaphragm. Individuals experiencing persistent symptoms of anemia, especially if they have a known hiatal hernia or symptoms suggestive of one, should consult a doctor for a comprehensive evaluation.