A hiatus hernia occurs when a portion of the stomach protrudes upward into the chest cavity through an opening in the diaphragm, the muscular wall separating the abdomen and chest. This opening, known as the esophageal hiatus, normally allows the esophagus to pass through to connect to the stomach. While many individuals with a hiatus hernia may not experience any symptoms, a “flare-up” signifies a period where symptoms intensify or worsen, causing notable discomfort.
Understanding a Flare-Up
A hiatus hernia flare-up manifests as uncomfortable symptoms, primarily stemming from acid reflux. Heartburn, a burning sensation in the chest, is a common complaint, often felt after eating. Regurgitation, where food or bitter fluids rise back into the throat or mouth, can also occur. Some individuals may experience chest pain or discomfort, which can sometimes be mistaken for heart-related issues, along with difficulty swallowing or a sensation of a lump in the throat. Bloating, burping, and nausea are additional symptoms that can accompany a flare-up, indicating irritation or increased pressure on the hernia.
Common Triggers
Various factors can contribute to a hiatus hernia flare-up by increasing abdominal pressure or irritating the esophagus. Dietary choices are frequent culprits, with fatty foods, spicy dishes, caffeine, alcohol, and acidic items like tomatoes or citrus fruits exacerbating symptoms. Lifestyle habits include consuming large meals, eating too close to bedtime, or lying down immediately after eating. Physical strain, such as heavy lifting, persistent coughing, or straining during bowel movements, can increase pressure and worsen a hernia. Stress and certain medications, including NSAIDs, may contribute.
Strategies for Relief
Managing flare-ups involves dietary and lifestyle adjustments to alleviate symptoms. Eating smaller, more frequent meals can reduce pressure, while avoiding identified trigger foods minimizes irritation. Staying hydrated and choosing non-acidic, high-fiber foods such as lean meats, non-citrus fruits, and whole grains promote comfort.
Lifestyle modifications include elevating the head of the bed by 6 to 8 inches to prevent reflux during sleep. Avoiding lying down immediately after eating and wearing loose clothing can reduce abdominal pressure. Techniques for stress reduction, along with weight management if applicable, can help manage symptoms, as excess weight adds pressure. Over-the-counter antacids provide quick relief by neutralizing stomach acid, while H2 blockers or proton pump inhibitors (PPIs) reduce acid production, though these are typically for short-term use without medical guidance.
When to Seek Medical Care
While many flare-ups can be managed with home remedies, certain symptoms warrant medical attention. Persistent or worsening symptoms, even after implementing lifestyle changes and over-the-counter medications, indicate professional evaluation is needed. Severe chest pain, especially with shortness of breath, jaw or arm pain, or sweating, requires immediate emergency care as these could signal a heart issue.
Other concerning signs include severe difficulty or pain when swallowing, and unexplained weight loss. Vomiting blood or passing black, tarry stools are serious symptoms suggesting gastrointestinal bleeding and require urgent medical assessment. These symptoms differentiate typical flare-up discomfort from serious complications requiring a doctor’s diagnosis and treatment.