A “hernia in your throat” is not a precise medical term, but commonly refers to a hiatal hernia. A hernia involves the protrusion of an organ or tissue through an abnormal opening. In a hiatal hernia, a portion of the stomach pushes up into the chest cavity through an opening in the diaphragm.
Understanding Hiatal Hernias
A hiatal hernia occurs when the upper part of the stomach extends upward into the chest through a small opening in the diaphragm, the muscle separating the chest from the abdomen. This opening, known as the hiatus, normally allows only the esophagus to pass through to connect with the stomach.
There are two primary types of hiatal hernias. A sliding hiatal hernia, the most common, occurs when the junction between the esophagus and stomach, along with part of the stomach, slides in and out of the chest through the hiatus. The less common, but potentially more serious, is a paraesophageal hernia. Here, a portion of the stomach pushes up into the chest alongside the esophagus, remaining in the chest cavity rather than sliding back down.
Recognizing the Signs
Many individuals with a hiatal hernia experience no symptoms. When symptoms do manifest, they are often associated with acid reflux.
Common indicators include:
Heartburn, a burning sensation in the chest, especially after eating.
Regurgitation of food or liquids.
Difficulty swallowing.
A feeling of a lump in the throat.
Chest pain, which can be mistaken for heart issues.
Shortness of breath.
Causes and Risk Factors
The exact cause of hiatal hernias is not always clear, but several factors contribute to their development. Increased pressure within the abdomen is a primary factor. This pressure can result from chronic coughing, repeated vomiting, or straining during bowel movements.
Heavy lifting, pregnancy, and obesity also elevate abdominal pressure, increasing the likelihood of a hiatal hernia.
Age-related weakening of the diaphragm muscles can make the hiatus larger, allowing part of the stomach to protrude. Some individuals may be born with a larger than usual hiatus.
Diagnosis and Management
Diagnosing a hiatal hernia involves medical history review and imaging studies. A barium swallow X-ray, where a patient drinks a chalky liquid, allows visualization of the esophagus and stomach. An upper endoscopy, using a thin tube with a camera, provides direct visualization of the esophagus and stomach lining, identifying the hernia and any inflammation. Esophageal manometry, which measures esophageal muscle strength and coordination, may also be used.
Management varies depending on symptom severity. For many, lifestyle modifications are effective. These include:
Eating smaller, more frequent meals.
Avoiding trigger foods like fatty or acidic items.
Elevating the head of the bed during sleep to reduce nighttime reflux.
Weight management.
Quitting smoking.
Medications are often prescribed to manage acid reflux symptoms. These include antacids for immediate relief, H2 blockers to reduce acid production, and proton pump inhibitors (PPIs) for stronger, longer-lasting acid suppression.
In severe cases or when complications arise, such as strangulation of the stomach, surgical repair may be necessary. This procedure involves pulling the stomach back into the abdomen and tightening the diaphragmatic opening. Consulting a healthcare professional for proper diagnosis and a personalized treatment plan is important.