The Be Well Podcast - Allison Porter, MD, FACS
Allison Porter, MD, FACS serves as the Chief of Surgery for Skagit Regional Health. She is a General Surgeon with specialty training in minimally invasive surgery and robotic surgery.
Caitlin Whyte (Host): Chest pain, bloating and burping can all be signs of a hiatal hernia. But what exactly is that? Joining us today to discuss hiatal hernias and gastroesophageal reflux disease is Dr. Allison Porter, a General Surgeon with specialty training in minimally invasive surgery and robotic surgery at Skagit Regional Health. Welcome to Be Well, the podcast from Skagit Regional Health. I'm your host, Caitlin Whyte. Doctor, to kickoff, our conversation here. What is a hiatal hernia?
Allison Porter, MD, FACS: Sure. So the definition of a hiatal hernia is when a portion of the stomach rises above the diaphragm. And the diaphragm is a very large muscle that extends all the way across the body. And every time you breathe,
it moves down to help your lungs expand. And then it moves back up again to help you exhale. And it has a natural hole called the hiatus, and that is so the esophagus can pass through the diaphragm to carry food from your mouth down to your stomach.
And the stomach's natural position is below the diaphragm. But for many people, a little bit, or sometimes a lot of the stomach will start rising up above the diaphragm, basically due to various pressures or tissue breakdown. And when that happens,
it's called a hiatal hernia.
Host: And then how is this different from gastroesophageal reflux and what is that condition?
Dr. Porter: So they're related and gastroesophageal reflux is when food, liquid or acid from the stomach washes backward up into the esophagus. And it's actually normal for everybody to have a little bit of that gastroesophageal reflux. But for some people, it happens more than it's supposed to. And that's when they'll get symptoms that require treatment. And the way they're related to a hiatal hernia is, when the stomach is in its appropriate position below the diaphragm, then the muscles of the stomach, esophagus and diaphragm are all lined up.
So the junction, which is called the gastroesophageal junction, it works as a one-way valve or it's supposed to. So food and liquid can go down, but then food, liquid, and acid don't go backward from the stomach back up into the esophagus. So when someone gets a hiatal hernia, then those muscles aren't lined up appropriately anymore. And the one way valve starts being more like a two way valve where that food, liquid, acid can kind of go both directions. And the esophagus isn't really made to tolerate a large amount of acid going backward. And when food goes backward, then sometimes it goes all the way up the esophagus and ends up in someone's mouth or throat. And so the gastroesophageal reflux is just the situation in which these things are going backwards when they're not supposed to be.
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