Hiatal Hernia vs Ulcer: What You Need to Know

Hiatal hernias and ulcers both involve the stomach, both involve stomach acid, and cause symptoms that can overlap. They can also occur at the same time.  It’s important to get the diagnosis right because each problem is fully treatable with this right combination of medicines and procedures.

What is important to note here is that both hiatal hernias and ulcers are medical problems that need to be dealt with effectively, once they are suspected of being there or diagnosed conclusively.


What is a Hiatal Hernia?

The diaphragm is a comparatively large, wall-to-wall (from one side of the abdominal/thoracic cavities to the other), highly stretchable muscle that separates the upper (the thoracic cavity) part of the human torso from the lower one (the abdominal cavity).

This organ has multiple functions but two of the most important are:

  1. Its role in separating the crucially important chest organs on top (the heart, lungs, esophagus, etc.) from the abdominal ones (the intestines, kidneys, bladder, pancreas, liver, etc.) on the bottom; and
  2. Helping the body to breathe by expanding the lungs to fill with air every time it contracts.

This muscle provides a passageway (the hiatus) through which the esophagus can connect to the stomach, allowing food to travel there from the mouth. Should any type of weakening occur to this muscle surrounding the hiatus, part of the stomach can push uncharacteristically through the diaphragm and into the thoracic cavity, what you get is what is called a “hiatal hernia.”

Interestingly, there are actually 2 types of hiatal hernias, a paraesophageal and a “sliding” type. Although the latter is more common than the former, paraesophageal hernias can have more severe symptoms; both, however, may contribute to something called gastroesophageal reflux disease or GERD.

Things like being born with an overly-extended hiatus, excessive pressure being put on the stomach, constipation, coughing, previous surgeries & injuries, concomitant disease, lifting heavy objects and vomiting can contribute to the development of a hiatal hernia. While anyone may suffer from a hiatal hernia, they are more common among the overweight and the elderly.


How Do You Know if You Have a Hiatal Hernia?

Many times, you may not even know that you have a hiatal hernia, there being few or merely mild symptoms. Such a hernia, though, is often discovered while undergoing medical imaging or an examination for unrelated (or possibly related) conditions. They may be spotted with an endoscope, or with the use of medical imaging (e.g., a chest X-ray).

Then again, as the hernias grow in size or severity, the following symptoms may pop up:

  • Belching
  • Heartburn
  • Abdominal discomfort/pain
  • Swallowing difficulty
  • A “fullness” feeling in the chest
  • Nausea
  • Breathing difficulties or asthma
  • Ulcers in the esophagus (precipitated by the highly caustic acidic juices that are abnormally pushed upwards into the esophagus)
  • Bleeding (most probably from the ulcers that may rupture)
  • Chest pain that may mimic a heart attack—i.e., as such, it can be intense, persistent & chronic


What Hernias and GERD Can Do To Your Esophagus

As a hiatal hernia gets worse or is not treated (possibly because it hasn’t yet been discovered or diagnosed), one of the possible dangerous developments is that acid from the stomach may impart significant damage to the lining of the esophagus. Slowly and gradually, erosive esophagitis (serious irritation of the esophagus) may set in which, at first, may only cause slight symptoms and, possibly, some difficulty swallowing, or swallowing accompanied by some discomfort.

As time goes by, and the situation worsens, a patient with a hiatal hernia (and the other contributing factors, like maybe too much acid being produced by the stomach, and a bacterium called H. pylori that is often found in these situations) can inflict dangerous problems like Barrett’s Esophagus, heartburn, burping/gas, scarring and ulcers.

As for these “ulcers,” they should first of all be distinguished from peptic ulcers, which generally occur along the lining of the stomach or initial part of the intestine (duodenum). The types of ulcers being discussed here, though, are found further up the digestive system—i.e., the esophagus; it should also be noted that the ulcers in question may be referred to under different terminologies or categories. Three such distinctive terms are hiatal hernia ulcers, erosions or Cameron ulcers, and discreet esophageal ulcers.

What must be remembered about these ulcers is that they are the direct result of ongoing damage to the esophagus from acid and, if the conditions that lead to them aren’t treated, serious long-term consequences may be the result, not the least of which are bleeding that can lead to iron-deficiency anemia, breathing difficulties, and violent coughing, sleep apnea and cancer.

The bottom line is that ulcers can be the result of hiatal hernias. In most cases, however, medicine and surgery can restore normal conditions, including reducing, and possibly eliminating, the problem of stomach acid coming back into the esophagus. Once this is accomplished, then it’s just a matter of giving treatments that will help the esophagus heal effectively.

Unfortunately, the damage already done may also require surgical intervention; otherwise, medications may be given, as well as lifestyle and dietary changes, that with time can help the esophagus heal. The esophagus in question, especially if exposed to stomach acid conditions for a long time (before being diagnosed), may not completely heal and may even deteriorate into permanent or difficult to treat conditions like Barrett’s Esophagus and, worse yet, malignant neoplasms (cancer).

Because the ulcers that hiatal hernias can contribute to or help make possible can be so dangerous and so permanently far-reaching, they need to be taken seriously and aggressively looked for, if a hiatal hernia is ever diagnosed.


Other Important Facts To Keep In Mind

–If a patient is ever diagnosed with chronic upper GI bleeding and/or iron-deficiency anemia, then Cameron lesions may be present if a hiatal hernia or GERD are also involved.

–People with esophageal ulcers may also be suffering from often related conditions, including acid-peptic ailments, reflux esophagitis, ischemia, mechanical trauma, breathing disorders (i.e., sleep apnea, chronic coughing, etc.), iron-deficient anemia, as well as acid mucosal injury.

–Hiatal hernias and the many complications and concomitant ailments that may come with them can be life-threatening, if their symptoms and ramifications aren’t treated adequately, preferably with the use of surgery.

— But the same can be said, unfortunately, for such serious diseases as obesity, high blood pressure, cancer, cardiovascular disease, etc. For the record, both hiatal hernias and esophageal ulcers shouldn’t be taken lightly and, if long-term good health is your goal, then both should be dealt with proactively and, once diagnosed, aggressively.


Why Choose The Surgery Group?

We remain committed to providing our patients with innovative, safe alternatives to open surgery. However, there are times when open surgery is warranted, and minimally invasive surgery is not an option. In cases such as these, our board-certified surgeons are prepared to perform conventional surgery and provide each patient with the compassionate, high-quality, personalized care they deserve.

OUR SURGEONS ARE NOT DIRECTLY OR INDIRECTLY ASSOCIATED WITH ANY HOSPITAL. As such, we can recommend the best place for your Surgery to be done. Our only interest is resolution of your health problem in the safest and easiest way. Any surgeon who works for a hospital is bound by the administrative policies dictated by that hospital which can affect your care. These surgeons may be encouraged to use techniques or consultants or diagnostic tests which benefit the hospital system and are not in the best interests of the patient.

Our surgeons are continually maintaining their skills and expertise. This is accomplished by keeping up with the latest surgical techniques and technological advancements in our field. Whether we are performing an open surgery, a minimally invasive procedure or a robot-assisted surgery, our expert surgeons can perform complex and delicate procedures with unmatched precision.

If you need surgical intervention for any of the conditions or diseases listed above, contact our office today, at 850-444-4777, to schedule an initial consultation with one of our Board-Certified Surgeons. We proudly serve Southwest Alabama (the Gulf Coast), Northwest Florida, Fort Walton Beach, Destin, Florida Panhandle, Milton, Foley, Atmore, Brewton and Santa Rosa County.