Hiatal Hernia

What is a hiatal hernia?

A hiatal hernia is a condition in which part of the stomach pokes through the diaphragm up into the chest. (The diaphragm is a muscle between your chest and abdomen that helps you breathe.)

Hiatal hernias are common after middle age. Usually they do not cause problems.

What is the cause?

Doctors don’t know what causes hiatal hernias. What they do know is that they happen more often after middle age and in people who smoke or are overweight.

What are the symptoms?

Many people with a hiatal hernia never have any symptoms. However, in some cases it causes stomach acid to flow back into the esophagus. (The esophagus is the tube that carries food from your throat to your stomach.) This backward movement of stomach acid is called reflux and can cause heartburn. A more serious form of the problem is called gastroesophageal reflux disease (GERD). Possible symptoms of reflux or GERD are:

• heartburn, which is a burning pain or warmth in your chest or throat, usually close to the bottom of the breastbone (especially after you eat large meals or lie down soon after eating)
• a bitter or sour taste in your mouth
• belching
• a feeling of bloating or fullness in the stomach

How is it diagnosed?

Because many hiatal hernias do not cause symptoms, they are often found during exams for other problems. If you have symptoms, your healthcare provider will ask about your medical history and examine you.

You may have tests to confirm the diagnosis and rule out other causes of your symptoms. These tests might include:

• barium swallow X-ray exam of the esophagus
• complete upper GI (gastrointestinal) barium X-ray study of the esophagus, stomach, and upper intestine
• endoscopy, a procedure that uses a thin flexible tube with a tiny camera placed in your mouth and down into your stomach so your provider can see your esophagus and stomach

How is it treated?

Treatment is usually not needed if you have no symptoms.

If you have heartburn or other symptoms, your healthcare provider may recommend a change in your diet. If you are overweight, you may also be given suggestions for losing weight.

Antacids can help you feel better when you have heartburn. Your provider may also prescribe medicine to reduce the amount of acid your stomach makes.

If your symptoms are severe and are not controlled by medicine or other measures, your provider may recommend surgery.

How can I take care of myself?

• Follow the treatment recommended by your healthcare provider.
• If you are overweight, try to lose some weight.
• If heartburn bothers your sleep, raise the head of your bed 6 to 8 inches by putting the frame on wood blocks. If you can't raise the frame of the bed, try placing a foam wedge under the head of your mattress. Sleeping on your left side may also help. Just using extra pillows will not help.
• Don’t smoke.
• If you usually eat 1 or 2 large meals a day, try to eat 3 or 4 smaller meals instead.
• Avoid drinking alcohol and eating foods that can make reflux worse, such as chocolate, mint-flavored foods, fatty foods, caffeine, citrus, or tomato products.
• Sit up during meals and wait at least an hour after eating before you lie down. It’s best to not eat for 2 to 3 hours before you go to bed.
• Wear loose clothing around your belly and avoid belts.