Hiatal Hernia

Any time an internal body part pushes into an area where it doesn't belong, it's called a hernia.

The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the abdomen. Normally, theesophagus (food pipe) goes through the hiatus and attaches to thestomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).

In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled," or have its blood supply shut off.

Many people with hiatal hernia have no symptoms, but others may have heartburn related to gastroesophageal reflux disease, or GERD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatal hernia without having GERD, and others have GERD without having a hiatal hernia.

People with heartburn may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed.

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What Causes a Hiatal Hernia?

Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as frompregnancy, obesity, coughing, or straining during bowel movementsmay also play a role.

Who Is at Risk for Hiatal Hernia?

Hiatal hernias occur more often in women, people who are overweight, and people older than 50.

How Is a Hiatal Hernia Diagnosed?

A hiatal hernia can be diagnosed with a specialized X-ray (using abarium swallow) that allows a doctor to see the esophagus or withendoscopy.

How Are Hiatal Hernias Treated?

Most people do not experience any symptoms of their hiatal hernia so no treatment is necessary. However, the paraesophaeal hernia (when part of the stomach squeezes through the hiatus) can sometimes cause the stomach to be strangled, so surgery is sometimes recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated. Symptoms of GERD, such as heartburn, should be treated.

When Is Hiatal Hernia Surgery Necessary?

If the hiatal hernia is in danger of becoming constricted or strangulated (so that the blood supply is cut off), surgery may be needed to reduce the hernia, meaning put it back where it belongs.

Hiatal hernia surgery can often be performed as a laparoscopic, or "minimally invasive," procedure. During this type of surgery, a few small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope that allows the surgeon to see inside the abdomen and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs to a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.

Many patients are able to walk around the day after hernia surgery. Generally, there are no dietary restrictions and the patient can resume his or her regular activities within a week. Complete recovery will take two to three weeks, and hard labor and heavy lifting should be avoided for at least three months after surgery. Unfortunately, there is no guarantee, even with surgery, that the hernia will not return.

When Should I Call the Doctor About a Hiatal Hernia?

If you have been diagnosed with a hiatal hernia and you develop severe pain in the chest or abdomen, become nauseated, are vomiting, or are unable to have a bowel movement or pass gas, you may have a strangulated hernia or an obstruction, which are medical emergencies. Call your doctor immediately.

Heartburn/GERD Health Center

Natural Home Remedies for Heartburn

In this article

• Do Herbal Heartburn Remedies Work?
• Are There Any Other Natural Treatments for Heartburn?
• Can Drinking Milk Help My Heartburn?
• Is Chewing Gum an Effective Way to Get Heartburn Relief?
• Finding Heartburn Relief at Home

Heartburn is very common -- and very unpleasant. It's triggered whenstomach acid backs up into the esophagus. It can make you feel as though someone has lit a small bonfire in your chest, and it's burning its way up to your neck.

You're probably well aware that medications can help calm the burn, but natural heartburn remedies and lifestyle changes may be another way to get relief.

One commonly used "natural" heartburn remedy is calcium. It's also the active ingredient in many over-the-counter antacids.

If you find yourself popping antacids like candy and you're having heartburn more than a couple of times a week, or if you are using antacids for longer than two weeks, it's time to see the doctor. You may have a condition called GERD -- gastroesophageal reflux disease. Frequent heartburn can lead to long-term problems. It can cause inflammation and strictures in your esophagus. In rare cases, it may even lead to cancer. But stopping the acid reflux can help prevent complications in the future.

Here is a rundown of some other commonly used home remedies for heartburn, and the evidence for their effectiveness.

Do Herbal Heartburn Remedies Work?

There isn't much research into herbal remedies for heartburn. Most of the research has centered on a product called Iberogast. It is made with 9 different herbs, including:

• Angelica
• Caraway
• Clown's mustard plant
• German chamomile
• Greater celandine
• Lemon balm
• Licorice
• Milk thistle
• Peppermint

Some studies have shown that Iberogast may reduce heartburn, stomach pain, cramping, and nausea. It's not clear, however, which herb in the mix relieves symptoms. Plus, peppermint oil can actually worsen heartburn, so it's not a good idea to take it if you have GERD.

Are There Any Other Natural Treatments for Heartburn?

Melatonin, a supplement used to aid sleep, has been suggested to help relieve heartburn. But the research is conflicting as to whether it is effective for this or any other gastrointestinal symptoms.

Before you decide to take any herbal remedy or supplement, check with your doctor. Some supplements can have side effects or can interact with medications you're already taking.

Natural Home Remedies for Heartburn

In this article

• Do Herbal Heartburn Remedies Work?
• Are There Any Other Natural Treatments for Heartburn?
• Can Drinking Milk Help My Heartburn?
• Is Chewing Gum an Effective Way to Get Heartburn Relief?
• Finding Heartburn Relief at Home

Can Drinking Milk Help My Heartburn?

You may have heard that drinking a glass of milk can relieve heartburn. While it's true that milk can temporarily buffer stomach acid,nutrients in milk, particularly fat, will stimulate the stomach to produce more acid.

Even though milk might not be a great heartburn remedy, however, it's a rich source of bone-buildingcalcium. Try fat-free skim milk and don't overdo it. Drink no more than 8 ounces of skim milk at a time -- as a snack in between meals. Overfilling the stomach may increase heartburn.

Is Chewing Gum an Effective Way to Get Heartburn Relief?

It may sound strange, but gum stimulates the production of saliva, which is an acid buffer. Plus, chewing gum makes you swallow more often, which pushes those nasty acids back out of your esophagus. When you pick a pack of gum, just make sure it's sugar-free so you also protect your teeth.

Finding Heartburn Relief at Home

A few simple strategies can help soothe the burn of heartburn:

• Watch what you eat. Avoid specific foods that trigger your heartburn, but also watch out for peppermint, caffeine, sodas,chocolate, citrus fruits and juices, tomatoes, onions, and high-fat foods. Eat more fiber to keep your digestive tract moving and healthy. Also, reduce your portion sizes. Try eating five or six small meals a day, rather than three big ones. Eating too much at once is a big heartburn trigger.
• Watch when you eat. Push away the plate at least two or three hours before bedtime so your stomach has a chance to empty before you lie down.
• Watch how you eat. Eat slowly, taking smaller bites.
• Lose weight. Excess abdominal fat can press against the stomach, forcing acids up into the esophagus. Follow a diet and exerciseprogram to shed extra pounds.
• Keep a diary. Write down what you've eaten and when yourheartburn symptoms occur so you can pinpoint which foods are your triggers and avoid them.
• Toss the cigarettes. Smoking can reduce the effectiveness of the muscle that keeps acids in the stomach. For this, and so many other health reasons, it's always the perfect time to quit.
• Loosen your belt. Ditch the skin-tight jeans. Tight clothes put added pressure on the abdomen.
• Tilt up. Put wood blocks under your bed to raise the head about 6 inches. Don't bother raising your pillows, though -- it's not effective for heartburn.

Super Foods for Optimal Health

Do your immune system a favor, and pack some more fruits and vegetables on your plate.

They're loaded with nutrients, called antioxidants, that are good for you.

Add more fruits and vegetables of any kind to your diet. It'll help your health. Some foods are higher in antioxidants than others, though.

The three major antioxidant vitamins are beta-carotene, vitamin C, and vitamin E. You’ll find them in colorful fruits and vegetables, especially those with purple, blue, red, orange, and yellow hues.

Beta-carotene and other carotenoids: apricots, asparagus, beets, broccoli, cantaloupe, carrots, corn, green peppers, kale, mangoes, turnip and collard greens, nectarines, peaches, pink grapefruit, pumpkin, squash, spinach, sweet potato, tangerines, tomatoes, and watermelon

Vitamin C: berries, broccoli, Brussels sprouts, cantaloupe, cauliflower, grapefruit, honeydew, kale, kiwi, mango, nectarine, orange, papaya, snow peas, sweet potato, strawberries, tomatoes, and red, green, or yellow peppers

Vitamin E: broccoli, carrots, chard, mustard and turnip greens, mangoes, nuts, papaya, pumpkin, red peppers, spinach, and sunflower seeds

These foods are also rich in antioxidants:

• Prunes
• Apples
• Raisins
• Plums
• Red grapes
• Alfalfa sprouts
• Onions
• Eggplant
• Beans

Other antioxidants that can help keep you healthy include:

Zinc: oysters, red meat, poultry, beans, nuts, seafood, whole grains, fortified cereals, and dairy products

Selenium : Brazil nuts, tuna, beef, poultry, fortified breads, and other grain products

Cooking tip: To get the biggest benefits of antioxidants, eat these foods raw or lightly steamed. Don’t overcook or boil them.

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Foods or Supplements?

Foods have many different nutrients in them, and they work together.Supplements don't have that same mix.

If you can’t get enough antioxidants in your diet, some experts recommend taking a multivitamin that includes minerals, too.

But chances are, you can get what you need from your diet. If you want to check that you're on track, ask your doctor or a dietitian.

Apple Cider Vinegar and Health

By Joy Manning, Reviewed by Elaine Magee, MPH, RD on October 1/, 014

You probably have a bottle of apple cider vinegar in your pantry right now. It’s a tasty addition to homemade pickles, marinades, and salad dressing, but is it also good for you?

As a folk remedy, apple cider vinegar has been credited with curing everything from theflu to warts. Many of its supposed benefits are unproven, but some experts think that adding a little of this sour liquid to your life may have some health benefits.

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Don't drink apple cider vinegar straight. It's so acidic that it could harm your tooth enamel and esophagus.

Apple Cider Vinegar and Weight Loss

Have you heard that apple cider vinegar will help you lose weight?

The only study to test the idea in people was done in Japan. In the study, 175 obese but healthy people took either vinegar or water daily for 12 weeks. Their diets were similar. They kept food journals. At the end of the study, those who used vinegar had lost slightly more weight. On average, the vinegar group lost 1-2 pounds over the 3-month period. They gained it all back after the study was over.

The researchers suggest that vinegar may turn on certain genes involved in breaking down fats.

The effect is probably very subtle, says Chicago dietitian Debbie Davis, RD. “It may have some benefits in terms of weight loss and weight management, but it is definitely not a quick fix."

If you want to lose weight, you’ll still need to exercise and practice portion control.

Apple Cider Vinegar and Blood Sugar

While apple cider vinegar probably won’t make you skinny, it does appear to help withdiabetes and blood sugar control.

Carol Johnston, PhD, directs Arizona State University’s nutrition program. She has been studying apple cider vinegar for more than 10 years and believes its effects on blood sugar are similar to certain medications.

“Apple cider vinegar’s anti-glycemic effect is very well documented,” Johnston says.

She explains that the vinegar blocks some of the digestion of starch. “It doesn’t block the starch 100%, but it definitely prevents at least some of that starch from being digested and raising your blood sugar,” Johnston says.

Apple Cider Vinegar and Blood Sugar continued...

Not every expert feels as confident about apple cider vinegar’s power.

"Trying to use vinegar to treat diabetes is like trying to bail out a flooded basement with a teaspoon," says Michael Dansinger, MD, director of Tufts University’s diabetes lifestyle coaching program.

He advises patients to focus instead on their overall diets -- a strategy backed by a lot more research, he says.

If you have gastroparesis, a common problem with diabetes that slows stomachemptying, be careful. Early research shows apple cider vinegar may make this problem worse.

"I’m concerned that drinking vinegar, even diluted in water, increases acid in your system, which puts a strain on your kidneys and bones,” Dansinger says.

If you have diabetes and want to try apple cider vinegar, let your doctor know, and keep an eye on your blood sugar levels.

Johnston stresses that if you are on medication for diabetes, you shouldn’t stop taking it and substitute vinegar. If you're thinking about using it to help manage your blood sugar, talk to your doctor first.

Apple Cider Vinegar and Digestion

If you drink apple cider vinegar with a starchy meal, then the starches you don't digest will feed the good bacteria in your gut, Johnston says.

Davis recommends using unfiltered apple cider vinegar, “the cloudy kind, where you can see a blob in the bottle.”

That blob is known as “the mother,” and it’s full of probiotics and other beneficial bacteria. “This kind of vinegar can support immune function and, for some people, even help with constipation,” Davis says.

Tips on Taking Apple Cider Vinegar

Don't drink it straight. It’s so acidic that it could harm your tooth enamel and youresophagus.

Don't use a lot. “Dilute 1 to 2 tablespoons in a big glass of water, and sip it along with your meals one or two times a day,” Johnston says.