A hiatal hernia is a condition in which a small part of your stomach bulges through a hole in your diaphragm. This hole is called a hiatus. It’s a normal, anatomically correct opening that allows your esophagus to connect to your stomach.
The cause of a hiatal hernia is usually unknown. Weak supportive tissues and increased abdominal pressure can contribute to the condition. The hernia itself can play a role in the development of both acid reflux and a chronic form of acid reflux called gastroesophageal reflux disease (GERD).
Hiatal hernias can require a variety of treatments, ranging from watchful waiting in mild cases to surgery in severe cases.
Hiatal hernias don’t usually cause symptoms that you’d notice until the protrusion of the stomach through the hiatus is quite large. Small hernias of this kind are most often asymptomatic. You may not be aware of one 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. These include:
- chest pain that intensifies when you bend over or lie down
- abdominal pain
- dysphagia (trouble swallowing)
- frequent burping
- sore throat
Acid reflux can be caused by a wide variety of underlying factors. Testing may be required to determine if you have a hiatal hernia or other structural abnormality that could be behind your GERD symptoms.
Talk to your doctor about reflux symptoms that don’t get better with lifestyle and diet changes or over-the-counter antacids.
Imaging tests are used to detect a hiatal hernia and any damage that could have been made by acid reflux. One of the most common imaging tests is the barium swallow X-ray, sometimes called an upper GI or esophagram.
You’ll need to fast for eight hours prior to the test to make sure that the upper portion of your gastrointestinal tract (your esophagus, stomach, and part of your small intestine) is clearly visible on the X-ray.
You’ll drink a barium shake before the test. The shake is 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 your doctor to look for inflammation or other factors that may be causing your acid reflux. These factors could include hernias or ulcers.
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 make sure 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, 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 (PPIs). They include:
- cimetidine (Tagamet)
- esomeprazole (Nexium)
- famotidine (Pepcid)
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- ranitidine (Zantac)
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. Foods that can trigger heartburn include:
- tomato products
- citrus products
- greasy food
Try not to lie down for at least three hours after eating to prevent acids from working their way back up your digestive tract. You should also quit smoking. Smoking can increase your risk of acid reflux. Also, being overweight (especially if you’re female) can increase your risk of developing both GERD and hiatal hernias, so losing weight may help alleviate your reflux symptoms.
Surgery to repair a hiatal hernia may be necessary 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
- have an 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 time after surgery may range from 3 to 10 days in the hospital. You’ll receive nutrition through a nasogastric tube for several days post-surgery. Once you’re allowed to eat solid foods again, make sure you eat small amounts throughout the day. This can help promote healing.