The conversation started with a discussion about what time we were going to eat dinner.

One person said, “I must eat early because I have a hiatal hernia and eating late makes it impossible for me to sleep.” Then she said that everyone in her family has a hiatal hernia which sent me scurrying to the Internet since both my grandmother and mother had one.

The Mayo Clinic’s website says that a hiatal hernia occurs “when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.”

Oh, that explains it. But the best news is that in most cases you don’t even know you have one unless it’s discovered by your healthcare provider while looking for something else to be wrong with you. Maybe that’s not such good news.

At any rate, a large hiatal hernia will let you know it’s there because it will cause food and acid to back up into your esophagus leading to heartburn.

According to GUT, an international journal of gastroenterology and hepatology, a study completed in 1999 concluded that although rarely documented, “familial inheritance of hiatal hernia does occur.” I also found that these hernias are very common (possibly up to 60 percent of people by age 60); why they happen is pretty much unknown, and it’s unusual for serious problems to develop.

Web MD describes the two main types of hiatal hernias: “In a sliding hiatal hernia, the stomach and the section of the esophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

“The paraesophageal hernia is less common, but is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the esophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become ‘strangled,’ or have its blood supply shut off.”

If this happens, surgery may be in order.

As for cause, they say that it could be that some of us are born with a larger hiatal opening. There’s the genetic connection. Or, that there can be increased pressure in the abdomen from coughing, vomiting or straining during bowel movements. Sudden physical exertion, pregnancy and obesity can play a role.

It’s time to see the medico when heartburn, belching, difficulty swallowing and chronic fatigue are persistent and not relieved with over-the-counter medications. Tests may include an x-ray of your upper digestive tract or a scope inserted down your throat (endoscopy).

The acid reflux caused by the hiatal hernia might be controlled with a few lifestyle changes. Mayo Clinic recommends trying to eat several smaller meals during the day rather than a few large meals. They also say to avoid foods that trigger heartburn such as chocolate, onions, spicy foods, citrus fruits and tomato-based foods. You should avoid alcohol. Lose weight. Stop smoking (yeah!). And, try elevating your head about six inches. And, it says to eat at least two hours before bedtime. So, our dinner party will be early in the evening. Decision made.

Kathy Hubbard is a trustee on Bonner General Hospital Foundation Board. She can be reached at 264-4029 or kathyleehubbard@yahoo.com.