A number of age changes occur in the gastro-intestinal tract. These include deterioration in oesophageal motility, prolongation of gut transit time and a consequent possibility of developing constipation. Hiatus hernia is the most common disease of the gastro-intestinal system. It refers to displacement of a portion of the stomach through the opening in the diaphragm through which the oesophagus passes from the chest to the abdominal cavity. In this disease, a part of the upper wall of the stomach protrudes through the diaphragm at the point where the gullet passes from the chest area to the abdominal area.
The diaphragm is a large dome-shaped muscle dividing the chest form the abdominal cavity. It is the muscle concerned with breathing and it is assisted by the muscles between the ribs during exertion. It has special openings in it to allow for the passage of important blood vessels and for the food channel, the oesophagus. Hiatus hernia occurs at the oesophagus opening.
There are two main types of hiatus hernia, known as 'sliding' type and 'rolling' or para-oesophageal type. In the first type, which is very common, the upper part of the stomach and the cardio-oesophageal junction rise up through the diaphragm by direct herniation through the hiatus. In the second type, with is far less common, a portion of the upper stomach herniates through the hiatus alongside the oesophagus so that cardio-oesophageal junction maintains its normal relationship to the diaphragm.
Hiatus hernia is characterised by pain in certain areas. The most common areas are behind the breast bone, at the nipple level and at the lower end of the breast bone. Pain also occurs on the left side of the chest and this is often mistaken for angina. Other areas of pain are the base of the throat, right lower ribs and behind the right shoulder blade. The pain increases when the patient stoops with effort and lies down.
Other symptoms of this disease are heart-burn, especially after a meal, a feeling of fullness and bloatedness, flatulence and discomfort on swallowing. The inflammatory changes often result in occult bleeding and when continued leads to iron deficiency anaemia. In feet, hiatus hernia is probably the main cause of iron deficiency anaemia due to blood loss in elderly patients.
The chief cause of the mechanical defect associated with hiatus hernia is faulty diet. The consumption of white flour, refined sugar and products made from them such as cakes, pastries, biscuits and white bread as well as preservatives, and flavouring devitalise the system and weaken the muscle tone. As a cosequence, the muscles become less resilient, and connective and fibrous tissue suffers through poor nourishment, and thus becomes more prone to decomposition and damage. This ultimately leads to diseases like hiatus hernia.
In the beginning of the treatment, it will be advisable to raise the head end of the bed by placing bricks below the legs of the bed. This will prevent the regurgitation of food during the night. More pillows can also be used for the same purpose.
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