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Dr. Shustina is an incredibly knowledgeable doctor who truly takes time to find root cause.
RG
Rochel Gordon
Condition · General & Women’s
Hiatal Hernia
Persistent heartburn, chest pain after eating, and difficulty swallowing that doesn't respond to acid-blocking medications aren't just GERD—they may signal a hiatal hernia, a condition affecting 15-20% of the general population and up to 60% of adults over age 50. Research shows that while Type I sliding hiatal hernias account for over 95% of cases and often contribute to gastroesophageal reflux disease, the underlying factors include weakened diaphragm muscles, increased abdominal pressure, and digestive dysfunction. Our comprehensive approach addresses both the structural aspects and the root causes that contribute to hernia development and associated symptoms.
What Exactly Is a Hiatal Hernia?
A hiatal hernia occurs when part of the stomach protrudes through the diaphragm's hiatus (the opening where the esophagus passes through) into the chest cavity. The diaphragm normally acts as a muscular barrier separating the abdominal and chest cavities, with the lower esophageal sphincter (LES) maintaining proper stomach position and preventing acid reflux. When a hiatal hernia develops, it compromises the LES function and can allow gastric contents to back up into the esophagus, leading to GERD symptoms. While smaller hernias may be asymptomatic, larger ones can cause significant digestive symptoms, breathing difficulties, and quality of life issues requiring comprehensive management of both structural and functional aspects.
Types of Hiatal Hernias and Their Characteristics
Hiatal hernias are classified into four types based on anatomy and severity, each requiring different assessment approaches and management strategies.
| Type | Anatomical Characteristics | Common Symptoms | Considerations |
|---|---|---|---|
| Type I (Sliding Hernia) | Gastroesophageal junction slides up through hiatus; accounts for 95% of cases | Heartburn, acid reflux, regurgitation, chest pain | Often manageable with lifestyle modifications and functional approaches |
| Type II (Paraesophageal) | Stomach fundus herniates beside intact esophagus | Chest pain, early satiety, shortness of breath | Risk of obstruction; may require surgical intervention |
| Type III (Mixed) | Combination of sliding and paraesophageal elements | Variable symptoms combining reflux and mechanical issues | Most complex type requiring comprehensive management approach |
| Type IV (Complex) | Additional organs (colon, spleen, small bowel) herniate into chest | Severe symptoms, respiratory compromise, abdominal pain | Highest risk category requiring immediate specialized care |
Why Hiatal Hernias Impact More Than Digestive Health
Hiatal hernias affect multiple body systems due to their impact on the diaphragm's dual role in breathing and digestion, as well as the disruption of normal gastroesophageal anatomy. The compromised lower esophageal sphincter function leads to chronic acid exposure, which can cause esophageal inflammation, respiratory symptoms from aspiration, and sleep disruption. Additionally, larger hernias can compress lung tissue, affecting breathing capacity and oxygen levels. The chronic inflammation from reflux can contribute to systemic inflammation, while the anatomical displacement can affect vagal nerve function, impacting overall digestive health, stress response, and autonomic nervous system balance.
Common Signs of Hiatal Hernias Include
Type I Sliding Hiatal Hernias:
- Heartburn and acid reflux, especially after meals
- Regurgitation of food or acid
- Chest pain that may mimic heart problems
- Difficulty swallowing (dysphagia)
- Chronic cough or throat clearing
- Acidic taste in mouth, especially upon waking
Paraesophageal Hernias (Types II-IV):
- Chest pain, particularly after eating
- Feeling of fullness after small meals
- Shortness of breath or breathing difficulties
- Heart palpitations
- Upper abdominal pain
- Nausea and vomiting
Systemic and Functional Symptoms:
- Chronic fatigue from poor sleep due to nighttime reflux
- Anxiety related to eating and symptoms
- Weight loss from eating difficulties
- Iron deficiency anemia from chronic blood loss
- Respiratory issues including asthma-like symptoms
- Voice hoarseness from acid exposure
Diagnostic Options at Whole Gut Health
Comprehensive hiatal hernia evaluation may involve both structural assessment and functional analysis of contributing factors. We are no longer doing endoscopic procedures. We welcome medical records of endoscopies to review for a second opinion. If endoscopy is needed, we have a network of recommended gastroenterologists in the Miami area who will perform the procedures and return care to Whole Gut Health for further treatment,
Testing options at Whole Gut Health may include:
Comprehensive Digestive Assessment including evaluation of stomach acid production, digestive enzyme function, and gut microbiome health.
Functional Lab Work including inflammatory markers, nutrient assessments, and evaluation for factors contributing to tissue weakness.
Diaphragmatic Function Evaluation to assess breathing patterns and diaphragm strength contributing to hernia development.
We customize diagnostic protocols based on your symptom pattern, hernia type, and overall health status to ensure comprehensive evaluation and optimal treatment planning.
Our approach
Why Whole Gut Health is different
At Whole Gut Health, we go beyond conventional symptom management and traditional functional medicine protocols. We trust your body's innate ability to heal itself when given the right support.
In Dr. Shustina's many years of practice, she has seen that many digestive diseases have their root cause in emotional traumas and unhealed wounds. When these underlying causes are healed, the body can heal from the inside out in a lasting way.
We focus on the mind-gut connection, incorporating energy healing techniques, personalized nutrition that evolves as you heal, and integrative approaches addressing mind, body, and spirit. If this resonates with you, contact our office to schedule your consultation and take the first step on your healing journey.
Our Hiatal Hernia Management Approach
Our Three-Phase Hiatal Hernia Protocol Includes:
Phase 1 — Assessment and Root-Cause Identification
- Comprehensive evaluation of hernia type, severity, and anatomical displacement
- Detailed analysis of digestive function, breathing patterns, and lifestyle factors
- Diaphragm weakness and breathing dysfunction
- Chronic increased abdominal pressure from constipation, obesity, or coughing
- Poor posture and core muscle weakness
- Digestive dysfunction affecting stomach emptying
- Stress and nervous system dysfunction
Phase 2 — Targeted Intervention
- Inflammatory conditions affecting tissue integrity
- Visceral Manipulation: An osteopathic technique which can manually and painlessly reduce a hiatal hernia
- Symptom Management: Natural anti-inflammatory support, and esophageal healing strategies for immediate symptom relief
- Digestive Optimization: Comprehensive protocols to improve stomach emptying, reduce reflux triggers, and restore normal digestive function
- Diaphragmatic Support: Breathing exercises, postural corrections, and therapies to strengthen diaphragm function and reduce hernia progression
Phase 3 — Rebuilding and Prevention
- Anti-Inflammatory Protocols: Dietary modifications and natural compounds to reduce esophageal inflammation and promote tissue healing
- Lifestyle Modifications: Weight management, eating habits, and positioning strategies to minimize symptoms and prevent worsening
- Comprehensive Tissue Support: Nutritional protocols to strengthen connective tissue and support diaphragm integrity
- Sustained Digestive Health: Long-term strategies for maintaining optimal digestive function and preventing reflux
- Postural and Breathing Optimization: Ongoing support for proper breathing mechanics and core strength to prevent progression
- Monitoring and Maintenance: Regular assessment to track improvement and prevent complications
Expert-Led, Personalized Care
Dr. Alexandra Shustina is a board-certified gastroenterologist and internist specializing in complex digestive disorders, gut health, and the gut–brain connection. Drawing from both conventional gastroenterology and integrative medicine, she takes a comprehensive approach to uncovering the underlying factors contributing to illness and guides patients toward lasting wellness.
At Whole Gut Health, every patient receives highly personalized care rooted in a deep understanding of digestive health, nutrition, the gut microbiome, and the interconnected systems that influence overall well-being. By combining evidence-based medicine with a thoughtful, individualized approach, we help patients move beyond symptom management and create a clear path toward long-term healing and vitality.
Frequently Asked Questions
Common questions, answered
What is a hiatal hernia?
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A hiatal hernia occurs when part of the stomach protrudes through the diaphragm's hiatus (opening) into the chest cavity. The diaphragm normally separates the abdominal and chest cavities, and when a hernia develops, it can compromise the lower esophageal sphincter function and allow gastric contents to back up into the esophagus, leading to GERD symptoms.
What are the different types of hiatal hernias?
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Type I (Sliding Hernia)
- Anatomical characteristics: Gastroesophageal junction slides up through hiatus; accounts for 95% of cases
- Common symptoms: Heartburn, acid reflux, regurgitation, chest pain
- Often manageable with lifestyle modifications and functional approaches
Type II (Paraesophageal)
- Anatomical characteristics: Stomach fundus herniates beside intact esophagus
- Common symptoms: Chest pain, early satiety, shortness of breath
- Risk of obstruction; may require surgical intervention
Type III (Mixed)
- Anatomical characteristics: Combination of sliding and paraesophageal elements
- Common symptoms: Variable symptoms combining reflux and mechanical issues
- Most complex type requiring comprehensive management approach
Type IV (Complex)
- Anatomical characteristics: Additional organs herniate into chest
- Common symptoms: Severe symptoms, respiratory compromise, abdominal pain
- Highest risk category requiring immediate specialized care
What are the common signs and symptoms of hiatal hernias?
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Type I Sliding Hernias: Heartburn and acid reflux, regurgitation, chest pain, difficulty swallowing, chronic cough, acidic taste in mouth
Paraesophageal Hernias: Chest pain after eating, feeling of fullness after small meals, shortness of breath, heart palpitations, upper abdominal pain, nausea
Systemic Symptoms: Chronic fatigue from poor sleep, anxiety related to eating, weight loss, iron deficiency anemia, respiratory issues, voice hoarseness
How are hiatal hernias diagnosed?
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Comprehensive evaluation may involve multiple diagnostic approaches. We welcome endoscopic records for a second opinion and can refer to a trusted network of Gastroenterologists for endoscopic procedures who will return care to Whole Gut Health. The following are done at Whole Gut Health.
- Comprehensive Digestive Assessment: Evaluates stomach acid production and digestive enzyme function
- Functional Lab Work: Includes inflammatory markers and nutrient assessments
Diagnostic protocols are customized based on symptom pattern and hernia type.
What does hiatal hernia treatment involve?
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Our comprehensive three-phase hiatal hernia protocol includes:
Phase 1: Assessment and Contributing Factor Identification
- Comprehensive evaluation of hernia type, severity, and anatomical displacement
- Detailed analysis of digestive function, breathing patterns, and lifestyle factors
- Assessment of contributing factors including diaphragm weakness, increased abdominal pressure, and digestive dysfunction
Phase 2: Targeted Intervention
- Visceral manipulation for manual reduction of the hernia
- Symptom management with natural acid reduction and anti-inflammatory support
- Digestive optimization to improve stomach emptying and reduce reflux triggers
- Diaphragmatic support with breathing exercises and postural corrections
- Anti-inflammatory protocols and lifestyle modifications
Phase 3: Long-Term Structural Support and Prevention
- Comprehensive tissue support with nutritional protocols to strengthen connective tissue
- Sustained digestive health strategies for maintaining optimal function
- Postural and breathing optimization for proper mechanics
- Monitoring and maintenance with surgical coordination when indicated
Why is it important to address contributing factors beyond the hernia itself?
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Hiatal hernias often result from underlying factors like diaphragm weakness, chronic increased abdominal pressure, and digestive dysfunction. Addressing only the hernia without correcting these factors can lead to recurrence or progression. A comprehensive approach targets root causes for better long-term outcomes.
Can hiatal hernias be managed without surgery?
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Many Type I sliding hiatal hernias can be effectively managed with comprehensive functional approaches including visceral manipulation, digestive optimization, diaphragmatic support, lifestyle modifications, and natural anti-inflammatory protocols.
What makes your approach to hiatal hernia management different?
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At Whole Gut Health, we take a comprehensive approach that addresses both structural and functional aspects:
- Evaluation of underlying factors contributing to hernia development
- Integration of conventional gastroenterology with functional medicine approaches
- Focus on diaphragmatic function, digestive optimization, and tissue support
- Personalized protocols based on hernia type and individual contributing factors
- Coordination with surgical specialists when surgical intervention is needed
Who provides hiatal hernia care at your practice?
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Dr. Alexandra Shustina is a board-certified gastroenterologist and internist who serves as Miami's premier gut health specialist. She has training in both conventional gastroenterology and functional gut health, with expertise in the gut microbiome and its role in health and wellness.
How do I get started with hiatal hernia evaluation and treatment?
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The first step is scheduling a comprehensive consultation where we'll:
- Review your symptoms, medical history, and any previous testing in detail
- Determine the most appropriate diagnostic strategy for your specific case
- Develop a personalized hiatal hernia management plan based on your hernia type and underlying contributing factors
Contact our office to schedule your initial consultation and begin your comprehensive approach to hiatal hernia management and optimal digestive health.
Reviews
The body remembers when it's finally heard
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Dr. Shustina goes to the root level of the issue, not only superficial, so there's healing.
LG
Leah Glickman
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She has significantly improved my health. I was suffering from Ulcerative Colitis and now live normally.
ML
Monica LaBadia
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Dr. Shustina has helped me change my lifestyle and heal my gut in a way I thought impossible.
DL
Dalit Lonstein
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She listens to patients and treats conditions, not symptoms.
GS
Gabriela Salazar
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Dr. Shustina is the best doctor I have ever been to. She assesses the root of the problem.
MS
M. S.
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She is an outstanding doctor who understands the body's ability to heal itself and holistic remedies.
SS
Sibel Sebi Sharabi
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Dr. Shustina has a wealth of knowledge and is helping me heal years of gastrointestinal issues.
DC
Daniela Chaparro
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Dr. Shustina is an amazing doctor. She diagnosed my cancer early and saved my life.
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Mordechai Weinstein
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After one session with Dr. Shustina, my digestive pain went away.
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Taryn Parascand
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Doctor Shustina is the absolute best. She has helped me resolve numerous issues other doctors dismissed.
RS
Rachel S.
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Dr. Shustina is a fantastic doctor who truly cares. Her holistic approach attacks the root cause.
CS
Clay Simonsen
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