Hiatal Hernia

Another structural abnormality that can cause heartburn and acid reflux, also known as gastroesophageal reflux disease (GERD), is a hiatal hernia. This type of hernia occurs when the upper part of your stomach pokes through a small opening in your diaphragm. This can weaken the lower esophageal sphincter (LES) and increase your chance of developing GERD.

The diaphragm is the muscle that separates your chest from your abdomen. The small opening in your diaphragm is called a hiatus. Your esophagus passes through the hiatus on its way to your stomach. A hiatal hernia occurs when your stomach pushes up through this opening, due to weakening support structures around the esophagus. Many people age 50 and older develop a hiatal hernia simply from the wear and tear of life; however, hiatal hernias affect people of all ages. Pregnant women may get them because of added pressure and weight from nearby organs. Coughing, vomiting, straining to move your bowels or sudden physical exertion can cause increased pressure in the abdomen and result in hiatal hernia.

Symptoms of Hiatal Hernia

• Heartburn
• Belching
• Difficulty swallowing

In most cases, a small hiatal hernia doesn’t cause problems and has no symptoms. A large hiatal hernia, however, can allow food and acid to back up into your esophagus, leading to heartburn and acid reflux/GERD. Lifestyle changes or over-the-counter medications can usually relieve these symptoms.

Lifestyle Changes for Hiatal Hernia

• Work with your doctor to treat heartburn or reflux disease with diet and medication
• Avoid spicy and fatty foods that may cause symptoms
• Eat smaller, more frequent meals
• Avoid lying down for three hours after eating
• Raise the head of your bed four to eight inches
• Avoid wearing tight clothing around your waist

Hernias usually do not require treatment unless there is danger of becoming strangulated (twisting and cutting off blood supply) or they are complicated by severe GERD or reflux esophagitis. Your doctor can diagnose hiatal hernias by performing an endoscopy or a barium esophagram of your upper digestive tract. Your doctor can determine whether your hiatal hernia is at risk of being twisted and if surgery is needed.

Hiatal hernia repair surgery is often combined with surgery for GERD. Conventional or laparoscopic herniorrhaphy can be used to repair the hiatal hernia. This technique allows the surgeon to pull the sac of hernia down out of the chest and repair the hole in the diaphragm. After the repair of the hernia defect, an operation called a Nissen fundoplication can be performed if needed. This operation will minimize the possibility of reflux.