Description

A hiatal hernia occurs when the upper part of the stomach bulges through the large muscle that separates the abdomen and the chest. The muscle called the diaphragm.

The diaphragm has a small opening called the hiatus. The tube used for swallowing food, called the esophagus passes through the hiatus before connecting the stomach. In a hiatal hernia, the stomach pushes up through that opening and into your chest.

A small hiatal hernia usually doesn't cause problems. You may never know you have one unless your healthcare team discovers that when checking for another condition.

But a large hiatal hernia can allow food and acid to back up into the esophagus. This can cause heartburn. Self-care measures or medications can usually relieve these symptoms. A large hiatal hernia may be that you need surgery.

Symptoms

Most small hiatal hernias cause no symptoms. But the large hiatal hernias can cause:

  • Heartburn.
  • Backward flow of the ingestion of food or liquids in the mouth, called regurgitation.
  • The reflux of acid from the stomach into the esophagus, called acid reflux.
  • Difficulty swallowing.
  • Chest or abdominal pain.
  • The feeling of being full after eating.
  • Shortness of breath.
  • Vomiting blood or passing black stool, which could mean that the bleeding in the digestive tract.

When to see a doctor

Make an appointment with your doctor or other health care professional if you have any duration of symptoms that worry you.

Causes

A hiatal hernia occurs when weakened muscle tissue allows the stomach to bulge through the diaphragm. It's not always clear why this happens. But a hiatal hernia can be caused by:

  • Age-related changes in your diaphragm.
  • An injury in the area, for example, after trauma or certain types of surgery.
  • Born with a large hiatus.
  • Constant and intense pressure on the surrounding muscles. This can happen while coughing, vomiting, straining during defecation, exercising or lifting heavy objects.

Risk factors

Hiatal hernias are more common in people who are:

  • 50 years of age or older.
  • Obese.

Diagnosis

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn, or pain in the chest or upper abdomen. These tests or procedures include:

  • X-ray of the upper part of the digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your health care team to view a summary of your esophagus, stomach and upper intestine.
  • A procedure to examine the esophagus and the stomach, called an endoscopy. Endoscopy is a procedure to examine your digestive system with a long, thin tube with a small camera, called an endoscope. The endoscope is inserted down the throat, and is seen in the inside of your esophagus and stomach and checks for inflammation.
  • A test to measure the contractions of the muscles of the esophagus, called an esophageal manometry. This test measures the rhythmic muscle contractions in the esophagus during swallowing. Esophageal manometry also measured the coordination and the force used by the muscles of the esophagus.

Treatment

Most people with a hiatal hernia do not experience any symptoms and don't need treatment. If you experience symptoms, such as heartburn and acid reflux, you may need medications or surgery.

Medications

If you experience heartburn and acid reflux, your health care professional may recommend:

  • Antacids neutralize the acid of the stomach. Antacids can provide quick relief. The overuse of some antacids can cause side effects, such as diarrhea or, sometimes, kidney problems.
  • Medications to reduce acid production. These medications are known as H-2-receptor blockers. They include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR). Stronger versions are available by prescription.
  • Medications that block acid production and heal the esophagus. These medications are known as inhibitors of the proton pump. They are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Proton pump inhibitors available without a prescription include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec, Zegerid). Stronger versions are available in prescription form.

Surgery

Sometimes a hiatal hernia requires surgery. The surgery can help people who are not helped by medications to relieve heartburn and acid reflux. The surgery can also help people who have severe complications of the inflammation or narrowing of the esophagus.

The surgery to repair a hiatal hernia may involve pulling the stomach in the abdomen and making the opening in the diaphragm smaller. The surgery may also involve the remodelling of the muscles of the lower part of the esophagus. This helps to keep the contents of the stomach come back. Sometimes, the surgery of hiatal hernia is combined with the weight-loss surgery, such as sleeve gastrectomy.

The surgery can be performed through a single incision in the chest wall, called a thoracotomy. The surgery can also be performed using a technique called laparoscopy. In laparoscopic surgery, the surgeon inserts a tiny camera and special tools through several small incisions in the abdomen. The operation is performed by a surgeon who views the images of the interior of the body, which are displayed on a video monitor.

Lifestyle and home remedies

Make some lifestyle changes can help control the symptoms caused by a hiatal hernia. Try:

  • Eat several small meals during the day instead of a few large meals.
  • Do not eat foods that trigger heartburn. These include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.
  • Avoid lying down after a meal or eating late in the day.
  • Maintain a healthy weight.
  • Stop smoking.
  • Elevate the head of the bed 8 inches (20 centimeters).

Preparing for your appointment

Make an appointment with a doctor or other health care professional if you have any symptoms that worry you.

If you have been diagnosed with a hiatal hernia and the problem persists after you make the lifestyle changes and the start of the medication, you may be referred to a doctor who specializes in diseases of the digestive system, called a gastroenterologist.

Because appointments can be brief, it is a good idea to be prepared. Here's some information to help you prepare.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there is anything that you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that do not seem to be related to the reason for which you scheduled the appointment.
  • Write down key personal information, including major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking and the dose.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write questions to ask their health care team.

Your time with your doctor or other health professional is limited, so preparing a list of questions can help you make the most of their time together. A list of questions from most important to least important in case time runs out. For the hiatal hernia, some basic questions to ask include:

  • What is likely causing my symptoms?
  • Other that the most likely cause, what are other possible causes of the symptoms?
  • What tests do I need?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

  • When did your symptoms begin?
  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Hiatal hernia