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Transcripts: 506-4 and 506-5

Week: 506.4 Guest: Robert Mathieson, M.D. Topic: Hiatal Hernia - Part One Host: Richard Roeder Producer: Ed Graham

ROEDER: This is the first half of a conversation on hiatal hernia with Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland, Dr. Robert Mathieson.

ROEDER: Dr. Mathieson, first before we get into the specific kind of hernia I wanted to talk to you about, first what does the term hernia mean in general?

MATHIESON: Hernia means that there is a weakness in a structure of the body - it can be a muscle, it can be a piece of tissue such as a connective tissue plane and it means that in that weakness a contiguous organ or another piece of contiguous tissue protrudes into that weakness.

ROEDER: The specific form of hernia I wanted to talk to you about was the hiatal hernia which apparently is something that's very common in Americans. Would you explain what that is.

MATHIESON: Again, there's a weakness in the diaphragm, the opening of the diaphragm to which the esophagus enters may become weakened or stretched and that allows for the upper part of the stomach we call the cardia to actually protrude up through this weakness so that the stomach position is now partially in the chest instead of being in the abdomen and that is what's called a hiatal hernia. That weakness comes in two varieties. It can be a sliding hiatal hernia or it can be fixed and a sliding hiatal hernia just simply means that the stomach goes up and down, up and down all the time through that weakness whereas a fixed hernia means that the stomach remains fixated or attached or positioned in the hiatus and it does not move up and down. It stays fixed.

ROEDER: Is this a potentially dangerous condition?

MATHIESON: This has been an argument for centuries about how important is a hiatal hernia to actual reflux, heartburn, indigestion, reflux-type problems. Back in the '50s and '60s, if you were to ask a doctor or a surgeon, they would have told you that hiatal hernias are a very important cause for reflux but then in the '70s and '80s, more sophisticated studies where we can actually measure refluxive acid in the esophagus and its effect on the esophagus, it was felt that a hiatal hernia was not an important contributor to reflux. Interestingly there are now more recent studies that seem to suggest that maybe in certain populations and in particular, men, one study happened to be in veterans that hiatal hernia repairs - reflux repairs were very well tolerated and seemed to help the patients considerably so hiatal hernia itself is a very common condition and does not necessarily mean that you'd have to be fixed unless you're having symptoms of reflux, heartburn, indigestion and are resistant to the usual therapies that we have for this.

ROEDER: Join me for the second half of my conversation on hiatal hernia with Dr. Robert Mathieson.


Week: 506.5 Guest: Robert Mathieson, M.D. Topic: Hiatal Hernia - Part Two Host: Richard Roeder Producer: Ed Graham

NEMA: This is the second half of a conversation on hiatal hernia, a very common condition, frequently without symptoms in millions of Americans. My guest is Dr. Robert Mathieson, Chief of Gastroenterology at Union Memorial Hospital in Baltimore, Maryland.

MATHIESON: If you get placed on Zantac, Tagament-type medications and other things that we have available nowadays, if you are not getting better, if you continue to have symptomatology and there's evidence by studies that there's damage going on to your esophagus, then you may need to have the hiatal hernia repaired.

NEMA: What is the cause of a hiatal hernia?

MATHIESON: As we all get older, we all tend to fall apart a little bit. We all tend to get lax, our muscles lax, and we get a little out of shape and that increased weight that we carry around our abdomen, lack of exercise and all these sorts of things just tend to stretch out the hiatus, the opening in the diaphragm.

NEMA: Just how common is hiatal hernia? I've certainly read that it's very prevalent in the population in this country. Is this something that frequently people come to you for some other condition and you discover this incidentally like happens with gallstones.

MATHIESON: Very often. We very frequently will pick up hiatal hernias and I think that the statistical analysis may be a little hard to come by but you very often just see it. You know, you have someone go in for an upper GI test. You're looking to see if they have an ulcer and they'll have a hiatal hernia. Oftentimes as I mentioned these are usually sliding hiatal hernias, in other words it tends to come and go. It's not a permanent type of problem. But it is a common occurrence but again, it does not correlate with the complaints of indigestion and heartburn so the presence of a hiatal hernia doesn't mean that you're going to have indigestion and heartburn and it doesn't have to be fixed in any particular way unless you are having symptoms and are resistant to treatment.

NEMA: You mentioned that one of the reasons that these seem to occur, is as people get older and muscles don't work as well and they gain weight, do you ever see hiatal hernias in children?

MATHIESON: There may be conditions in which children may develop hernias in this area but they are often related to a special type of hernia which we call paresophagial hernias. These are conditions which may be related to birth anomalies and things of this nature and you don't very often see a classic hiatal hernia in a child. It's only these paresohphagial-type hernias that you might see early in childhood.

NEMA: Does there seem to be a greater prevalence of hiatal hernias in adult men or adult women?

MATHIESON: No. Again it's one of these conditions which are equally seen in men and women and across all racial backgrounds and it certainly is more prevalent as we get older.

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