Before you climb the gurney to get under the knife, try this Hail Mary! (#3)

Hiatal hernias occur when part of the stomach pushes through the diaphragm into the chest cavity. While the exact cause is not always clear, several factors contribute to their development. Hiatal hernias are fairly common affecting roughly 9.9% of the population according to a 2015 American Journal of Gastroenterology published study.

What are some of the most common causes of a Hiatal Hernia?

– Age-related changes to the diaphragm
– Injury to the area
– Being born with a larger hiatal opening
– Increased abdominal pressure from:
– Lifting heavy objects
– Pregnancy
– Obesity
– Chronic straining during bowel movements
– Coughing or vomiting

What are the top risk factors?

– Age over 50
– Female gender
– Obesity
– Smoking
– Pregnancy
– Family history/genetics
– Certain autoimmune diseases

Treatments

Non-surgical Treatments

1. Medications:
– Antacids to weaken stomach acid
– Proton pump inhibitors (PPIs) or H-2 receptor blockers to reduce acid production
– Prokinetics to strengthen the esophageal sphincter

What are the risks of medicines for reflux caused by a hiatal hernia?

  1. Increased risk of cardiovascular disease.

  2. Higher likelihood of chronic kidney disease.

  3. Potential increased risk of upper gastrointestinal cancer, including stomach cancer.

  4. Elevated risk of bone fractures, particularly hip fractures.

  5. Higher chances of gastrointestinal infections.

  6. Possible magnesium deficiency.

  7. Potential increased risk of dementia, especially with prolonged use (over 4.4 years).

It is important to note that these risks are primarily associated with long-term use of PPIs, and the severity may vary depending on the duration and dosage. Recent studies have called for further investigation into the link between PPIs and stomach cancer, suggesting that a large, randomized control trial is needed to clarify this association.

Additional side effects of PPIs may include:

  • Diarrhea or loose stools

  • Headache

  • Nausea and vomiting

  • Abdominal pain

  • Dizziness

  • Difficulty breathing

  • Rash or itching

2. Lifestyle changes:
– Weight loss
– Avoiding large meals
– Quitting smoking
– Elevating the head of the bed

3. Chiropractic Protocol?

There is a technique used by chiropractors that has proven clinically to be helpful to many patients. The protocol consists of specific adjustments to the spine, collar bones and sternum, as well as a soft tissue manipulative maneuver just below the sternum in the abdomen. It appears as though it works best for those who have more mild hiatal hernias, but because there is little to no research that has been done, this is an assumption based on patient experience, reports and previous investigation of the hiatal hernia. This technique has not known side effects or even mild risks. Any risks are statistically insignificant in contrast to surgeries and medications.

Surgical Treatments

Surgery may be recommended for severe symptoms, large hernias, or when complications occur. Common surgical procedures include:

1. Nissen fundoplication: A laparoscopic or robotic procedure that wraps the upper part of the stomach around the lower esophagus

2. Hiatal hernia repair: This involves:
– Returning the stomach to its normal position
– Reducing the size of the hiatus
– Reinforcing the diaphragm

3. Endoluminal fundoplication: A less invasive procedure performed through the mouth

Surgery is typically performed using minimally invasive techniques, with a recovery period of 2-6 weeks. Hiatal hernia surgeries have shown to be generally effective, with success rates varying depending on the specific procedure and follow-up duration:

  1. Laparoscopic Nissen fundoplication:

    • 77.1% of patients reported excellent quality of life at a median follow-up of 3.7 years.

    • 82.3% of patients were symptom-free and off medications at a median follow-up of 5.6 years in a large Swedish study.

    • 93% of patients were doing well after 10 years in one study.

  2. Laparoscopic hiatal hernia repair (LHHR) with biologic mesh:

    • Significant improvement in GERD symptoms, with mean GERD-HRQL scores decreasing from 18.5 to 4.4 at a mean follow-up of 14.5 months.

    • Only 3.6% of patients had documented anatomic hernia recurrence.

  3. Transoral Incisionless Fundoplication (TIF):

    • Up to 99% “success rate” in performing the procedure.

    • 91% of patients experienced reduction in hiatal hernia.

    • 89% of patients were able to stop taking PPI medication.

    • Symptom relief typically lasts 8-10 years.

  4. Hiatal hernia surgery in general:

    • 90% success rate reported, with most people able to discontinue medications and enjoy life free of acid reflux.

However, it’s important to note that recurrence rates can increase over time:

  • Up to 50% of hiatal hernias may eventually return after surgery, usually after many years.

  • Recurrence rates after initial hiatal hernia repair range between 3% and 42%, with aggregate average recurrent rates of 10-15%.

  • Published failure rates from laparoscopic fundoplication range from 10% to 20%, with 3-6% of patients requiring revisional surgery.

 

Portland, Maine chiropractor and acupuncturist, Dr. Lou Jacobs, has been using the chiropractic protocol for hiatal hernia for decades, and it has proven helpful in almost every case. Dr. Lou is always accepting new patients in need of help. He accepts all major insurance and has dramatically reduced out of pocket prices for those who prefer to pay without insurance and who are committed to preventive maintenance  care that insurance companies refuse to pay for. To schedule with Dr. Lou or to learn more, call (207) SPINAL-1 or email sandra@drloujacobs.com