What is a hiatal hernia and how does it affect GERD?
Some doctors believe a hiatal hernia may weaken the lower esophageal sphincter (LES) and cause reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the stomach from the chest. Recent studies show that the opening in the diaphragm acts as an additional sphincter around the lower end of the esophagus. Studies also show that hiatal hernia results in retention of acid and other contents above this opening. These substances can reflux easily into the esophagus. Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen, resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and older have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages. Hiatal hernias usually do not require treatment
