Hiatal Hernia: Portland Clinic of Holistic Health: Holistic Medical Group

Hiatal Hernia: Portland Clinic of Holistic Health: Holistic Medical Group

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A Hiatal Hernia is when the stomach slips up above the diaphragm (the flat muscle below the heart and lungs that separates the upper chest from the abdomen).  This may result in a variety of symptoms such as fatigue, shortness of breath, and acid reflux.  Hiatal hernia syndrome occurs when the sphincter that separates the esophagus and the stomach loses it’s tone and becomes relaxed, creating the symptoms of a hiatal hernia without actual displacement of the stomach.  These can affect stomach and digestive function, causing reflux and heart burn as the sphincter is no longer aligned.  Digestion will be disrupted and minerals and certain vitamins (such as B12) will no be absorbed as well.  Poor vitamin and mineral absorption will create problems on the Biochemical plane.  The lowered mineral reserves may cause muscle cramps, or disrupt the nerves, making us jittery and anxious emotionally, or unfocused mentally.  The stomach in the upper chest will interfere with heart and lung action, impoverishing the blood, making us fatigued, perhaps provoking anxiety from the discomfort itself.
Identifying the primary plane, the root of the problem — the mechanical — allows us to treat the root cause.  The secondary problems or branches — the mental and biochemical — can be properly supported while the root is returned to health.  Chasing problems in the branches — the anxiety, palpitation, cramps, etc. — would leave us chasing the branch symptoms and no the cause.  Ignoring the need to support these branches would likewise prolong suffering.  Understanding organ and tissue relationships and proportion of importance are part of the process of building health.
Understanding this approach is key to understanding the natural holistic approach to health.  It is part of what clearly distinguishes the natural approach as the rational and sensible path to health.

NATUROPATHIC DIAGNOSIS OF A HIATAL HERNIA

What can we do naturally to identify and treat a Hiatal Hernia, or the even more common Hiatal Hernia Syndrome?  Diagnosis of a hernia with x-ray or endoscopy is an option — though we make use of it very rarely for this purpose.  A much more simple procedure is to check the diagnostic physical reflexes that are present when a Hiatal Hernia or Syndrome is present.  These diagnostic reflexes — under the left rib cage, between the 4th ribs on the front and side of the chest, and on the left of the spine, between the 11th and 12th vertebrae — are uncomfortably tender when a hiatal hernia is present.  With treatment, these reflexes will reduce in tenderness, sometimes immediately disappear, and are a useful guide to treatment.

CONVENTIONAL DIAGNOSIS AND TREATMENT OF A HIATAL HERNIA

When a hiatal hernia is suspected in conventional medicine, an endoscopy or x-ray is performed.  If a frank hernia is found, the options for treatment are acid inhibitors and surgical repair.  Unfortunately, both of these approaches have problems.  We need very acidic stomach secretions to properly absorb vitamins, minerals, and proteins.  Long term use of acid inhibitors causes numerous health problems — contributing to such problems as osteoporosis and Alzheimer’s.  The surgical repair is oftentimes unsuccessful and as with all cutting surgical approaches, comes with risk of improper surgical repair, infection, scar tissue, etc.

NATUROPATHIC TREATMENT OF HIATAL HERNIA

The Mechanical aspect of both hiatal hernia and hiatal hernia syndrome generally respond very well to soft tissue manipulation.  In this procedure, we gently relax the upper abdomen and gently manipulate the stomach into correct position.  The procedure can take anywhere from ten to 20 minutes.  Anywhere from one to five procedures may be necessary over a period of time.

The technique of reducing a hiatal hernia was formerly known as ‘bloodless surgery’ or ‘manipulative surgery. ’  Dr. Adolf Lorenz, a European physician, was a master of the art who pioneered techniques in the early 20th century.  One of his pupils was Dr. Byron White, whom he trained in the 1920’s..  The late Dr. White directed the Happy Acres Memorial Hospital in McMinnville, OR, which closed with his passing in the late 1960’s.  The hospital specialized in a variety of manipulative surgery techniques such as hiatal hernia treatment, repositioning of displaced kidneys, manipulating gallstones out of gall ducts, kidney stones out of ureter tubes, repositioning torn menisci of the knee, treating lumbar discs, and a good deal more.  Dr. Lloyd Jacobs was a physician who worked at the hospital and was trained by Dr. White.  Dr. Blake was fortunate to be trained by Dr. Jacobs in many of these techniques.

Holistic Treatment of the Person with Hiatal Hernia

The Mental/Emotional or Biochemical problems associated with hiatal hernia — such as cramps from low calcium and magnesium, anxiety from low B-vitamins, etc. — are readily supported naturopathically as the body returns to health.    If the esophagus has been irritated by the reflux, herbal treatment is very effective at healing these tissues.

It is very important to note that the muscular sphincter that separates the tender esophagus from the harsh acidic stomach enzymes is stimulated to constrict, to tighten, and thus protect the esophagus by the stomach acid itself.  Thus, low stomach acid levels will not stimulate the sphincter and allow the esophagus to be irritated.  Low acid levels for the stomach and sphincter may well still be too much for the tender esophagus — which is why lowering the levels even further with acid-inhibitors helps people symptomatically.  However, a muscle we do not use…we lose — so strengthening the sphincter is important for complete treatment.  Digestive enzymes and self-massage of reflex points can be very useful.  A series of Bio-Thermal Therapy™ Treatments are very powerful to restore proper tone and rhythm to the stomach, to hold it in proper position, to improve digestive secretions, and greatly increase the strength of sphincters of the stomach.

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Hiatal Hernia Symptoms & Treatment

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A hiatal or hiatus hernia happens when part of your stomach comes up through the diaphragm, the muscle that separates your chest area from your stomach area (abdomen). The tube that leads from your mouth to your stomach (esophagus) goes through a part of the diaphragm called the hiatus. If the muscle around the hiatus is weak, the top part of your stomach can press up through the diaphragm into the chest area and you may need hiatal hernia treatments.

Symptoms of a hiatal hernia

Most hiatal hernias present no symptoms and need no treatment. More serious hiatal hernia symptoms may include trouble swallowing, heartburn, belching, tiredness and chest pain. Schedule an appointment with your doctor if you have these symptoms and they are causing you concern. If you’re feeling chest pain, call your doctor immediately, as this may be a sign of a more serious condition.

Getting a hiatal hernia diagnosis

To diagnose a hiatal or hiatus hernia, your doctor will perform a physical exam. They’ll talk to you about your symptoms of hiatal hernia and may order tests, including:

• Endoscopy: A flexible tube equipped with a light and tiny camera (endoscope) is inserted down your throat to see inside the esophagus and stomach. If needed, a tissue sample (biopsy) can be done during an endoscopy. These samples are examined in a lab to check for problems.
• pH monitoring: This test checks for stomach acid in your esophagus.
• Motility testing: This measures if the esophagus is working properly. A thin, flexible tube (catheter) is inserted into your nose, down the esophagus and into the stomach.

Hiatal hernia services & treatment

Hiatal hernia treatments may include these dietary and lifestyle recommendations:

• Eat smaller more frequent meals
• Avoid fatty foods, alcohol, chocolate, caffeine and peppermint
• Don’t smoke
• Maintain normal weight
• Do not lie down after eating
• Do not eat for three to four hours before bedtime
• Elevate your head by six inches with a pillow wedge

Over-the-counter or prescriptions medicines may be used for hiatal hernia treatments, such as:

• Antacids. These will address symptoms of hiatal hernia but won’t fix any damage stomach acid has caused in your esophagus.
• H-2 receptor blockers. These heartburn medications reduce the amount of acid the body makes. They can help relieve symptoms of hiatal hernia for longer periods of time.
• Proton pump inhibitors. These block the acid the body makes, which allows the esophagus to heal.

Sometimes your doctor’s suggestion for hiatal hernia treatment may include surgery.

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Treatment of hiatal hernia

Drug therapy

In the 80-90s of the twentieth century, the number of patients requiring surgical treatment significantly decreased. This was due to the emergence of new antisecretory, antacid and prokinetic drugs. Over the past decade, the developed drug treatment regimens have significantly reduced the risk of complications and improved the quality of life of patients with mild to moderate reflux esophagitis. However, the main problem of conservative treatment was and remains an almost complete relapse of the disease after the termination of the next course of drug therapy. The untimely performance of the operation for reflux esophagitis and HH is largely due to the fact that surgeons and gastroenterologists still do not have a unified point of view on the tactics of treating patients with these pathological conditions. Disputes continue about the indications for its surgical treatment and the timeliness of the transition from conservative to surgical treatment. Particularly controversial are the issues of choosing treatment tactics for mild and moderate reflux esophagitis.

Undesirable is the use of drugs that reduce the tone of the LES (theophylline, progesterone, antidepressants, nitrates, prostaglandins, calcium antagonists, β-blockers, anticholinergic drugs), as well as having an adverse effect on the mucosa of the esophagus (non-steroidal anti-inflammatory drugs, doxycycline, quinidine) .

Drug treatment should be aimed at reducing the acidity of gastric juice, neutralizing the produced hydrochloric acid and accelerating the evacuation of food from the stomach. To this end, therapy may include the use of various groups of drugs.

Antacids (almagel, maalox, phosphalugel, gastal, etc.) and alginates (gaviscon, topalkan, etc.) are superior to other drugs in terms of the speed of achieving a therapeutic effect (pain and heartburn relief). Antacids are prescribed for symptomatic purposes, their action is aimed at neutralizing the acid and, unfortunately, for a short time. Their main active ingredients are aluminum hydroxide, magnesium trisilicate, bismuth nitrate. Some of the above complex antacids are available in tablets, others – in the form of a gel. The frequency of their intake is determined by the severity of clinical symptoms, usually 4-5 times a day between meals and at bedtime. The advantage of these drugs is good tolerability by most patients and the rapid onset of the clinical effect.

There are, however, adverse effects of taking antacid preparations. In particular, aluminum-containing drugs with prolonged use can cause hypophosphatemia and constipation. After a series of chemical transformations, these preparations form poorly soluble compounds excreted with feces in the human intestine, which include phosphorus. This can be avoided by the appointment of phosphorus-containing agents (for example, phosphalugel, but its alkalizing ability is less than that of almagel).

Massive therapy with calcium carbonate leads to alkalosis and is contraindicated in hypercalcemia, osteochondrosis, the presence of calcium-containing stones in the kidneys and gallbladder.

Taking into account the important role of esophageal and gastric motility disorders in the pathogenesis of EC, prokinetics – drugs that normalize the motility of the gastrointestinal tract, improve the function of the lower esophageal sphincter, occupy a significant place in the treatment of such patients. Prokinetics increase LES pressure, improve esophageal clearance and gastric emptying.

H ₂ histamine receptor blockers. The emergence of this group of drugs has opened an era of effective drug therapy to reduce the secretion of hydrochloric acid. Appeared in the 1970s, they played a big role in the treatment of gastric and duodenal ulcers. However, these drugs were less effective in treating reflux esophagitis. Currently, there are 5 generations of H ₂ blockers: I generation – cimetidine; II – generation – ranitidine; III generation – famotidine; IV generation – nizatidine; V generation – roxatidine. Currently, drugs from the group of ranitidine (zantac, ranitin) and famotidine (quamatel, famosan, gastromsidine) are most widely used, which are prescribed mainly for catarrhal forms of EC. These drugs effectively reduce the basal secretion of hydrochloric acid in the stomach and inhibit the secretion of pepsins. In the treatment of patients with erosive forms of the disease, they often turn out to be insufficiently effective even when taking double doses (600 mg of ranitidine and 80 mg of famotidine per day) and therefore gave way to their place inhibitors H ⁺ , K ⁺ py) , which is currently the most powerful antisecretory drugs.

Proton pump inhibitors (omeprazole, lansoprazole and pantoprazole) were introduced into clinical practice in the late 1980s [7]; rabeprazole and esomeprazole appeared not so long ago. Usually also given in double doses (omeprazole 40 mg, lansoprazole 60 mg, pantoprazole 80 mg), they achieve healing of esophageal erosions in 85-90% of patients, including those resistant to H ₂ blockers. The drugs of this group are practically devoid of side effects since they exist in the active form only in the parietal cell.

At the same time, recent studies have shown that when using the usually recommended therapeutic dose of omeprazole (20 mg 2 times a day), approximately 20% of patients with EC retain pronounced changes in intraesophageal pH, and in almost 1/3 of patients, it is required to obtain a therapeutic effect the use of doses of omeprazole, significantly higher than the standard therapeutic doses (up to 140 mg per day).

The main course of treatment of EC exacerbations (especially erosive and ulcerative forms of EC) requires at least 8-12 weeks. At the same time, discontinuation of medication after achieving healing of esophageal erosions in many patients leads to a rapid recurrence of the disease. Therefore, many patients require maintenance treatment with proton pump blockers or prokinetics (in half daily doses) for at least 1 year, which allows maintaining disease remission in most patients.

Complications of taking antisecretory drugs .

According to recent publications, the number of patients with partial or complete non-response to the standard dose of PPI (once a day for 8 weeks) is 40-50%.

The “ rebound syndrome ” described in the literature leads to a sharp increase in gastric secretion after the withdrawal of antisecretory therapy due to hypergastrinemia. The development of the “rebound” syndrome was noted already after 2-4 weeks of taking h3-blockers and 6-8 weeks of taking PPIs . Of course, a sharp increase in acid secretion can provoke an acute ulcer, but this probability is higher with the use of H ₂ -blockers.

The existing “ fatigue syndrome” of receptors is clinically significant and characteristic of all drugs of the h3-histamine receptor blocker group. It is known that after 5-7 days of continuous use of H2-blockers, the effectiveness of therapeutic doses is reduced by more than 50%, and with longer use, the antisecretory effect is completely lost.

The literature describes the phenomenon of “nocturnal acid breakthrough” – a decrease in pH in the stomach below 4.0 for several hours in the period from 22 to 6 hours while taking PPIs. The development of this phenomenon was found in almost 70% of patients with reflux esophagitis and 80% of patients with Barrett’s esophagus, and is probably associated with an increase in the activity of the vagus nerves at this time and a decrease in the formation of mucus by additional cells

Studies show that with long-term use antisecretory drugs cause the development of atrophic gastritis with intestinal metaplasia in patients with competitive infection with Helicobacter pylori, which is described in more detail in the corresponding chapter.

Many authors confirm a 2-3-fold increase in the risk of developing diarrhea caused by Clostridium difficile against the background of long-term PPI therapy.

The relationship between long-term PPI use and fractures is still debatable. The review by L. Laine compared the data of 13,556 patients with hip fractures older than 50 years and 135,386 persons who made up the control group matched by sex and age for PPIs.