Hiatal Hernias

A hiatal hernia is a condition in which a small part of your stomach bulges through a hole in your diaphragm. This hole, called a “hiatus,” is a normal, anatomically correct opening that allows your esophagus to connect to your stomach

The cause of a hiatal hernia is unknown, but weak supportive tissues are thought to play a role, according to the U.S. National Library of Medicine (NLM). The hernia itself can play a role in the development of acid reflux, or GERD.

Hiatal hernias require a variety of treatments, ranging from watchful waiting in mild cases to surgery in severe cases.

Symptoms

Hiatal hernias don’t usually manifest symptoms until the protrusion of the stomach through the hiatus is quite large. Small hernias of this kind are most often asymptomatic and you may not be aware of them unless you undergo medical testing for an unrelated condition.

Larger hiatal hernias are big enough to allow undigested food and stomach acids to reflux into your esophagus. This means that you’re likely to display the standard symptoms of GERD, including:

  • heartburn
  • chest pain that intensifies when you bend over or lie down
  • fatigue
  • dysphagia (trouble swallowing)
  • frequent burping
  • sore throat

Acid reflux can be caused by a wide variety of underlying factors. Diagnostic testing may be required to determine if you have a hiatal hernia or other structural abnormality that contributes to GERD symptoms.

Speak to your healthcare provider about reflux symptoms that don’t resolve with lifestyle and diet changes or over-the-counter antacids.

Diagnosis

Imaging tests are used to detect a hiatal hernia and any damage possibly incurred by acid reflux. One such diagnostic tool is a barium swallow X-ray, sometimes called an “upper GI.”

You’ll need to fast for eight hours prior to the test to ensure that the upper portion of your gastrointestinal tract (i.e. your esophagus, stomach, and part of your small intestine) is clearly visible on the X-ray.

Before the test, you’ll drink a barium shake—a white, chalky substance. The barium makes your organs easier to see on the X-ray as it moves through your intestinal tract.

Endoscopic diagnostic tools are also used to diagnose hiatal hernias. An endoscope (a thin, flexible tube equipped with a small light) is threaded down your throat when you’re under sedation. This allows a doctor to look for inflammation or other factors, like hernias or ulcers, which may be causing your acid reflux.

Treatment

Treatment for a hiatal hernia varies widely and should be tailored to your individual health concerns. Small hernias that show up on diagnostic tests but remain asymptomatic may just need to be watched to ensure that they don’t become large enough to cause discomfort.

Over-the-counter heartburn medications can provide relief from the occasional burning sensation that might stem from a moderately sized hiatal hernia. They can be taken as needed throughout the day in most cases. Calcium and magnesium-based antacids are most commonly stocked in the “Digestive Aids” aisle of your local drugstore.

Prescription medications for GERD not only give you relief, but some can also help heal the lining of your esophagus from hernia-related acid reflux. These medications are divided into two groups: H2 blockers and proton pump inhibitors (PPI).

They include:

  • cimetidine
  • esomeprazole
  • famotidine
  • lansoprazole
  • omeprazole
  • ranitidine

Adjusting your eating and sleeping schedule can also help manage your GERD symptoms when you have a hiatal hernia. Eat small meals throughout the day and avoid foods that trigger heartburn, such as tomato and citrus products, greasy food, chocolate, peppermint, caffeine, and alcohol.

Try not to lie down for at least three hours after eating to prevent acids from working their way back up your digestive tract. Quit smoking, as this can also increase your risk of acid reflux.

Surgery

Surgery to repair a hiatal hernia may be warranted when drug therapy, diet modifications, and lifestyle adjustments don’t manage symptoms well enough. Ideal candidates for hiatal hernia repair may be those who:

  • experience severe heartburn
  • suffer from esophageal stricture (a narrowing of the esophagus due to chronic reflux)
  • have severe inflammation of the esophagus
  • have pneumonia caused by aspiration of stomach acids

Hernia repair surgery is performed under general anesthetic. Laparoscopic incisions are made in your abdomen, allowing the surgeon to gently push the stomach out from the hiatus and back into its normal position. Stitches tighten up the hiatus and keep the stomach from slipping through the opening again.

Recovery from surgery may range from three to 10 days in the hospital. You’ll receive nutrition through a nasogastric tube for several days post-surgery. Once you’re allowed solid foods, eat small amounts throughout the day to promote healing.

The Female Experience

Women are more likely to get hiatal hernias than men, according to studies reported in a 2012 issue of the Archives of Surgery. Women took heartburn medications at a higher rate than men and experienced more dysphagia when recounting their GERD and hernia symptoms in the studies.

Female hernia sufferers faced with the same GERD-related problems are also more likely than their male counterparts to be overweight when undergoing reflux surgery. Being overweight can increase your risk of developing both GERD and hiatal hernias.