According to the Mayo Clinic, a hiatal hernia occurs at the opening of the diaphragm where the esophagus joins the stomach. Part of the stomach protrudes through the opening, resulting in a hiatal hernia.
When medication and lifestyle changes do not relieve painful symptoms, a hernia procedure may be necessary.
Risk Factors
You have an increased chance of developing a hiatal hernia if:
You're over age 50
You're overweight
You're a smoker
Symptoms
Small hiatal hernias usually don't require treatment. Larger hernias may cause:
Heartburn
Frequent Belching
Chest Pain
Nausea
Tests and Diagnosis
Doctors may discover a hiatal hernia while performing one of these procedures:
Barium X-ray: You drink a chalky liquid containing barium, so that the doctor can get a clear view of your esophagus, stomach, and the upper part of your small intestine. This X-ray shows whether the contents of your stomach are backing up into your esophagus.
Endoscopy: A thin, flexible tube with a fiber-optic light and attached video camera system is passed down your throat and into your esophagus and stomach to check for tissue inflammation.
Treatment
Taking prescription or over the counter antacids can reduce the acidity in your esophagus, and provide heartburn relief. If you stop taking antacids, your symptoms will return.
H-2 blockers block histamine receptors, which reduces the amount of acid your stomach secretes. H-2 blockers can be bought over the counter, and should be taken before a meal.
You can take these medications after a meal, but you'll be suffering with heartburn while you're waiting the 30 minutes for the medication to take effect.
Lifestyle Changes
Your doctor may suggest implementing some lifestyle changes to ease gastroesophageal reflux symptoms that can accompany a hiatal hernia. These changes may include:
Eat small meals: Heavy meals can cause your stomach to distend, pushing it up into your chest.
Lose weight: If you're overweight, losing excess weight helps put less pressure on your stomach.
Losing weight is the most important thing you can do to relieve painful symptoms.
Don't Smoke: Smoking increases acid production, and causes dry saliva. Saliva helps protect your esophagus from excess stomach acid.
Avoid spicy foods and alcohol
Elevate the head of your bed: Elevating the head of your bed 6 to 9 inches prevents stomach acid from backing up into your esophagus while you sleep.
Use a foam wedge to raise your mattress, and avoid pillows, which can put too much pressure on your abdomen.
Open Repair
In this procedure, you're given a general anesthetic, so you're asleep during the entire procedure.
The surgeon pulls your stomach down into the abdomen, and makes your diaphragm opening smaller by removing the hernia sac or reconstructing a weak esophageal sphincter. An open repair can be done using a single incision in either your chest wall or abdomen. The surgery usually takes two to three hours. Patients stay in the hospital up to six days.
Laparoscopic Procedure
The surgeon makes a small incision in your abdomen, and inserts a thin hollow tube through it. The mini camera inside the tube displays a picture of the surgical area on a large viewing screen. Surgical instruments are slid through the hollow tube, and the surgeon performs the rest of the hiatal hernia surgery while watching the viewing screen. If there are no complications, you will stay in the hospital for up to three days.
Laparoscopic surgery is preferred by many patients because there's less scarring and a shorter recovery time.
