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Sliding Hiatus Hernia: How I fixed my Reflux

Updated: Apr 3

What is a hiatus hernia?

Also called hiatal hernia (HH), is where the diaphragm muscle (that separates the chest from the abdomen) becomes weakened, this allows part of the stomach to push up through a diaphragm hole.

Thereby, part of the stomach is located in the lower part of the chest. There's SLIDING (80% of HH patients) or PARAESOPHAGEAL/ ROLLING (20% of HH patients)


Symptoms (may not experience all)

  • Abdominal or chest pain

  • Acid reflux

  • Heartburn

  • Food/liquids come back up the throat

  • Difficulty swallowing

  • Belching or hiccups

  • Gurgling in your chest

  • Nausea

  • Loss of appetite

  • Shortness of breath


With part of the stomach in the diaphragm, this can weaken the lower oesophageal sphincter (LES), and allow acidic stomach contents to go back up the oesophagus. Excessive damage to the lining can cause serious complications such as ulcers or Barrett's Oesophagus.


Causes of Hiatus Hernia

  • Injury (a blow to the chest or abdomen)

  • Age (diaphragm muscle weakens with age)

  • Increasing abdominal pressure: pregnancy, overweight or obesity, lifting heavy weights, tight compressing clothes

  • Sharp, physical movements: coughing, vomiting, straining


My experience

Initially, I experienced abdominal pain in December 2018 while in Japan, which got better with over time.

It returned February 2019 after a few weeks of celebrations (anniversary, v-day and birthdays). After this delicious week full of food, I burped frequently and felt a dull, gnawing pain between my rib cage. One day whilst working and sipping on French pressed coffee (I rarely drink coffee but I needed caffeine!), and the pain got worse. Looking back, it may have been due to weight training + stress + gastric inflammation.

I woke up in the middle of the night with heart racing and panicked. Possibly from difficulty breathing or tightness within the chest.. this kept me up for a further 3 hours, worsening anxiety during the day. My mind constantly raced with an inability to switch off my central nervous system – autopilot Fight-or-Flight response. In addition, I had minimal appetite for meals. This meant sipping on broth or soups with added protein to prevent muscle wasting.


After a breath test for H.Pylori to rule out stomach ulcer, ultrasound and a gastroendoscopy; a small sliding hiatus hernia was finally discovered. Interestingly enough, both my mother and brother have HH...



Note: a size of 2cm is required to be diagnosed as hiatal hernia. So you may actually have one, but its not large enough to be reported. Try the below treatment and see if it helps.

Acid suppressing medication?

A GP may prescribe to the suffering patient: an antacid such as Mylanta, proton pump inhibitor perhaps Nexium or even a H2 blocker, Zantac as an example, to reduce acid reflux up the oesophagus. Symptom relief? Yes. Problem solved? No. Suppressing acid reflux is a temporary fix. Symptoms commonly return once medications stop- this causes dependence as well as prolonged suffering. From July 2017-June 2018, PPis were one of the top ten most prescribed medications in Australia with established long term side effects of Vitamin B12 and Iron deficiencies (hello fatigue, blood disorders and poor mental health).

We understand there's a structural abnormality ie. Hiatus hernia. Suppressing reflux short-term isn’t the answer. Treat the cause and the reflux and pain will improve.


Treatment Plan

After extensive research, trial and error and patience; I found the following worked a treat without prescription drugs.

Let me quickly explain to give you context:

First of all, the diaphragm is a MUSCLE. Muscles can be manipulated. Often a weakened diaphragm allows part of the stomach through, this tightens and results in unpleasant symptoms.


Goal 1: Provide symptom relief & protect GIT lining

Goal 2: Release tight diaphragm muscle, reposition stomach back under chest and strengthen diaphragm muscle


How?


1) Avoid digestive irritates i.e caffeine, alcohol, spicy, fried foods, hard meats, raw vegetables

2) Slippery elm bark powder: twice a day soothes the stomach and lower oesophageal tissue lining


3) Physical manipulation

a. Massage: in the morning on an empty stomach drink two cups of hot water, and massage diaphragm under rib cage.

b. Heel drops:

Put your hands behind your head, raise on top of your toes –breathe in deeply-

and DROP hard down on your heels - breath out deeply.

Do this ~15 times.

c. Diaphragm breathing

Arm above head, take short shallow breaths, targeting the diaphragm muscle


4) Supplements

Zinc carnosine -commonly used in functional medicine, repairs stomach ulcers due to its slow zinc release within the stomach. A 2007 study showed zinc carnosine decreased gastric and small intestinal injury, and stabilized gastrointestinal mucosa lining.


Digestive enzymes- to relief pressure on the digestive system by supplying additional pancreatic enzymes. This breaks down protein, fats and carbohydrates.


Probiotics- Lactobacilus Rhamnosus 2.5 Billion

A meta-analysis consensus showed a moderate yet significant reduction in IBS related abdominal pain (severity and frequency) in children patients. Several studies have shown LGG protection against a range of pathogens such as salmonella.


Outcomes Approx. 1-2 weeks

BEFORE:

Burping 9/10 (Daily multiple times! Especially with increase in abdominal pressure from lifting weights) Pain 9/10 (Constant gnawing dull discomfort)

Nausea 8.5/10 (Vomit x1)

Loss of appetite 10/10 (Prioritised soup with easily to digest protein)


AFTER:

Burping 1/10 (Only if overeating or sculled water)

Pain 1/10 (Even if I poke firmly between rib cage, inflammation and pain greatly reduced) Nausea 0 /10 (None)

Loss of appetite 0/10 (Appetite returned to normal after digestive support)


Remember this was my own personal experience and may be different to yours. I do not endorse this will cure the condition completely. However, if you are looking for natural therapies after little success with conventional treatment, I recommend anyone with a small sliding hiatus hernia to feel empowered to take matters into their own hands If you have a large HH, and the above methods do not help, surgical correction may be clinically indicated. Please discuss with your GP.


To investigate whether your reflux is caused by a HH, ask for a GP referral to a gastroenterologist for an endoscopy. My test was painless under local local anaesthetic, over in 15 minutes, a report to the GP, a simplified findings report to the patient, and biopsy completed to rule out celiac disease, H. Pylori infection or degree of cell damage.


>> if you experience any of the symptoms mentioned above, please please investigate further with a gastroendoscopy to assess the severity of gastritis (inflammation) and even Barrett’s oesophagus (high risk of cancer due to chronic damage oesophagus tissue). Getting answers will no doubt assist with targeted treatment.

CLICK HERE to get in touch if you have any questions :) Until next time, ~ Bonny. C


Gastroenterologist

Dr Han Ter

Darebin Endoscopy Services

42 Station Street,

FAIRFIELD, 3078



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Reference

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Gracie, D. J., & Ford, A. C. (2016). The possible risks of proton pump inhibitors. Med J Aust, 205(7), 292-3.

Hütt, P., Shchepetova, J., Loivukene, K., Kullisaar, T., & Mikelsaar, M. (2006). Antagonistic activity of probiotic lactobacilli and bifidobacteria against entero‐and uropathogens. Journal of Applied Microbiology, 100(6), 1324-1332.

Horvath, A., Dziechciarz, P., & Szajewska, H. (2011). Meta‐analysis: Lactobacillus rhamnosus GG for abdominal pain‐related functional gastrointestinal disorders in childhood. Alimentary pharmacology & therapeutics, 33(12), 1302-1310. Kahrilas, P. J., Kim, H. C., & Pandolfino, J. E. (2008). Approaches to the diagnosis and grading of hiatal hernia. Best practice & research. Clinical gastroenterology, 22(4), 601–616. doi:10.1016/j.bpg.2007.12.007

Kaltenbach, T., Crockett, S., & Gerson, L. B. (2006). Are lifestyle measures effective in patients with gastroesophageal reflux disease?: an evidence-based approach. Archives of internal medicine, 166(9), 965-971. Mahmood, A., Fitzgerald, A. J., Marchbank, T., Ntatsaki, E., Murray, D., Ghosh, S., & Playford, R. J. (2007). Zinc carnosine, a health food supplement that stabilises small bowel integrity and stimulates gut repair processes. Gut, 56(2), 168-175.

Ruscin, J. M., Lee Page, R., & Valuck, R. J. (2002). Vitamin B12 deficiency associated with histamine2-receptor antagonists and a proton-pump inhibitor. Annals of Pharmacotherapy, 36(5), 812-816.

https://www.nps.org.au/australian-prescriber/articles/top-10-drugs-2017-18 Image A source https://www.msdmanuals.com/en-au/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/hiatus-hernia

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