Hiatal Hernia

What is Hiatal Hernia?
A hiatal hernia is an extremely common condition which usually does not cause any symptoms or problems. However, you may experience heartburn and regurgitation, from stomach acid refluxing up into the esophagus. On rare occasions some patients can experience chronic acid reflux which may over time cause injury and bleeding. Chronic inflammation of the lower esophagus (esophagitis) may also produce scarring and narrowing in this area.

What causes a Hiatal Hernia?
The diaphragm is a sheet of muscle that separates the lungs from the abdomen. The diaphragm contains a small hole through which passes the esophagus that carries food and liquids to the stomach. Normally this hole, called a hiatus, is small and fits snugly around the esophagus. The stomach sits below the diaphragm. In some people, the hiatus or hole in the diaphragm weakens and enlarges. This allows a portion of the stomach to herniate, or move up, into the chest cavity through this enlarged hole. It is not known why this occurs. It may be due to heredity, while in others it may be caused by obesity, exercises such as weightlifting, or straining at stool. Hiatal hernias occur in up to 60 percent of people by age 60.

The diagnosis of a Hiatal Hernia is typically made by an upper GI barium x-ray or an endoscopy.

Treatment for a hiatal hernia is only called for when the hernia results in symptoms, such as persistent heartburn or difficulty in swallowing. If there is inflammation or ulceration in the esophagus from acid reflux, treatment is also required.

General guidelines for treating heartburn and acid reflux:

  • Avoid foods and substances that increase reflux of acid into the esophagus, such as:
    • Nicotine (cigarettes)
    • Fatty foods
    • Alcohol
    • Caffeine
    • Chocolate
    • Peppermint and spearmint
  • Eat smaller, more frequent meals and do not eat within 2-3 hours of bedtime or lying down.
  • Avoid bending, stooping, tight belts, and girdles, all of which increase abdominal pressure and cause reflux.
  • If overweight, lose weight. Obesity increases abdominal pressure.
  • Certain medications, such as intestinal anti-spasmodics, calcium channel blockers, and some anti-depressants weaken the lower esophageal sphincter muscle.
  • Elevate the head of your bed 8 to 10 inches by putting a wedge under the upper part of the mattress or by placing blocks under the head of your bed. Gravity then helps keep stomach acid out of the esophagus while sleeping.

In mild cases of hiatal hernia, when reflux symptoms are persistent, making the above modifications and taking occasional antacids (Tums, Mylanta, Maalox, Rolaids, etc.) may be sufficient. In more severe cases of reflux, stronger medication (Zantac, Tagamet, Prilosec, Prevacid, Aciphex, Nexium, Protonix) may be prescribed by your doctor to effectively reduce the secretion of stomach acid, thereby reducing acid reflux. Short term use of these medications is very safe; the effects of long term use are not yet known.

Surgery is reserved for those patients with symptoms that cannot be controlled with medications.