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 that helps you breathe. It normally separates the abdominal cavity from the chest cavity.)

Hiatal hernias are common after middle age. They do not often cause problems.

How does it occur?

The cause of hiatal hernias is not known. What is known is that they occur more often in people after middle age, overweight people (especially women), and smokers.

What are the symptoms?

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

• a burning pain in the lower chest called heartburn (especially after you eat large meals or lie down)
• a bitter or sour taste in the back of your throat
• bloating and belching
• discomfort or pain in your stomach or esophagus
• vomiting.

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 do a physical exam.

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

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

How is it treated?

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 symptoms of heartburn. Your provider may also prescribe medicine to reduce the amount of acid your stomach makes.

If these treatments do not control your symptoms, surgery may be needed.

How can I take care of myself?

• Follow the treatment recommended by your healthcare provider.
• If you are overweight, try to lose some weight. Ask your healthcare provider for help.
• Sleep with your head raised at least 4 to 6 inches. This is usually best done by putting the head of your bed on blocks.
• If you smoke, quit.
• If you usually eat 1 or 2 large meals a day, try to eat 3 or 4 smaller meals instead. Do not eat during the 2 to 3 hours before you go to bed.
• Avoid foods and other substances that seem to cause heartburn, such as foods high in fat, tomato-based foods, spicy foods, orange juice, coffee, and alcohol.
• Sit up during meals and for at least 1 hour after the meals.
• Avoid tight clothes and belts.