Hiatal Hernia Symptoms & Treatments

June is Hernia Awareness Month, so we are taking a look at hiatal hernia, which is a common type of hernia that causes GI issues. Some people may not experience hiatal hernia symptoms, especially if the hernia is small. Others who have larger hiatal hernias may experience mild to severe symptoms similar to those of GERD. 

About Hiatal Hernia

A hiatal hernia is a condition in which the top of the stomach bulges through an opening in your diaphragm (the large muscle that separates your chest and abdomen). There is a small opening in the diaphragm that allows the esophagus to pass through the muscle before connecting to the stomach. This opening is called the hiatus. There are two types of hiatal hernia: 

• Sliding hiatal hernia: This is the most common type of hiatal hernia and occurs when the stomach and esophagus slide into and out of your chest through the hiatus. These hernias are usually small and don’t cause many symptoms if any.
• Fixed hiatal hernia: Fixed hiatal hernias are also called paraesophageal hernias and are less common than sliding hiatal hernias. They occur when part of the hernia slips through the diaphragm, but unlike the sliding hernia which moves in and out, fixed hernias stay outside of the hernia. Usually fixed hiatal hernias are not serious but there is a risk of serious complications if the stomach is blocked.

This condition occurs because of weakened muscle tissue in the diaphragm. This may be caused by injury to the area, age-related changes, or persistent pressure on the diaphragm. A hiatal hernia can occur in people of any age and gender. However, according to the National Institutes of Health (NIH), it is most common among people over 50 who are overweight or smokers.

Hiatal Hernia Symptoms

• Heartburn
• Backflow of stomach acid into the esophagus (acid reflux)
• Regurgitation of foods or liquids into the mouth
• Chest or abdominal pain
• Difficulty swallowing
• Belching
• Coughing
• Shortness of breath
• Nausea and vomiting
• Trouble emptying the bowels
• Blood in vomit or stools

Diagnosing Hiatal Hernias

If you are experiencing hiatal hernia symptoms, then you should consult a gastroenterologist to be evaluated. Because GERD has similar symptoms but is not always caused by hiatal hernia, testing is needed to diagnose hiatal hernia. A gastroenterologist may perform the following tests to evaluate your condition:

• Barium swallow: X-rays of your upper digestive system are taken after you drink a chalky liquid called barium. The liquid coats the inside of your digestive tract and allows the doctor to see the silhouette of your esophagus, stomach, and upper intestine.
• Upper endoscopy: A thin, flexible tube called an endoscope is inserted down your throat. The endoscope has a light and a camera at the end so that the doctor can examine the inside of your esophagus and stomach.
• Esophageal manometry: This is a test that measures the rhythmic muscle contractions of your esophagus as you swallow. If hiatal hernia is present, these contractions may be abnormal.

Hiatal Hernia Treatments

The treatment for this condition depends on the hiatal hernia symptoms you’re experiencing as well as how severe the hernia is. Treatment options include lifestyle changes, medication, and home remedies.

Lifestyle Changes

Lifestyle changes you can make to manage hiatal hernia symptoms include:

• Eating smaller meals more frequently throughout the day
• Avoiding foods that trigger heartburn and reflux
  • Fatty or fried foods
  • Alcohol
  • Tomato sauce
  • Garlic
  • Mint
  • Caffeine
• Waiting two to three hours after eating before you lie down
• Managing your weight
• Elevating the head of your bed about 6 inches to prevent reflux

Medication

Medications can be used to control hiatal hernia symptoms such as heartburn. These medications include:

• Antacids to neutralize stomach acid
• H-2-receptor blockers to reduce acid production
• Proton pump inhibitors (PPIs) to block acid production so that the esophagus can heal

Surgery

If medication and lifestyle changes do not help relieve the symptoms of hiatal hernia, your doctor may recommend surgery. Hiatal hernia repair surgeries can be done using the following techniques:

• Open repair: The surgeon makes a large incision in the abdomen and pulls the stomach back into place. Then, they wrap part of the stomach around the esophagus to create a tighter sphincter between the esophagus and stomach. This is sometimes called a Nissen Fundoplication.
• Laparoscopic repair: This surgery is performed through 3 to 5 small incisions in the abdomen. The doctor uses a laparoscope and special surgical instruments to perform the repair by pulling the stomach back into place and wrapping it around the esophagus.
• Endoluminal or endoscopic fundoplication: This is a newer procedure that is less invasive than both open and laparoscopic repair. The surgeon uses an endoscope to place clips in the esophagus to prevent stomach acid from backing up into the esophagus.
• Magnetic sphincter augmentation: This is another newer procedure that is performed laparoscopically. The surgeon operates through small incisions and places a small bracelet-like device made of magnetic beads around the esophagus to create a tighter sphincter. 

If you have symptoms or signs of hiatal hernia, you should consult a specialist like a gastroenterologist. They will be able to diagnose you and recommend a treatment plan to best manage your symptoms. The team at Birmingham Gastroenterology has decades of experience treating diseases and disorders in all parts of the digestive system. 

During this time we are offering telemedical services in order to provide care to patients without coming into the office. To make an appointment to discuss your symptoms and treatment options, call us at (205) 271-8000.