By Dr Saravana.K
Consultant Physician, Gastroenterologist & Hepatologist
A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.
Most small hiatal hernias cause no signs or symptoms. However, larger hiatal hernias can cause signs and symptoms such as: heartburn; belching; difficulty swallowing; chest or abdominal pain; feeling especially full after meals; or vomiting blood or passing black stools, which may indicate gastrointestinal bleeding.
Hiatal hernia could be caused by:
- Injury to the area
- Being born with an unusually large hiatus
- Persistent and intense pressure on the surrounding muscles, such as when coughing, vomiting or straining during a bowel movement, or while lifting heavy objects.
Hiatal hernia is most common in people who are: age 50 or older, or obese.
Hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. Such tests or procedures include:
- Barium swallow. During this procedure, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
- Endoscopy. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.
If you experience heartburn and acid reflux, your doctor may recommend medications, such as:
- Antacids that neutralize stomach acid
- Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal.
Surgery to repair a hiatal hernia
In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for people who aren’t helped by medications to relieve heartburn and acid reflux.
An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.
Making a few lifestyle changes may help control the signs and symptoms of acid reflux caused by a hiatal hernia.
- Eat several smaller meals throughout the day rather than a few large meals.
- Avoid foods that trigger heartburn, such as chocolate, onions, spicy foods, citrus fruits and tomato-based foods.
- Avoid alcohol.
- Eat at least two to three hours before bedtime.
- Lose weight if you’re overweight or obese.
- Stop smoking.
- Elevate the head of your bed 6in (about 15cm).