Hiatus Hernia

Symptoms: 

Most hiatus hernias don’t cause any symptoms. If you do get symptoms, they are unlikely to be serious.

A sliding hiatus hernia can cause a problem called gastro-oesophageal reflux disease (GORD). This is when acid or bile in the stomach rises back up into your oesophagus.

The most common symptom of GORD is heartburn, which causes a warm or burning sensation in your chest. The burning feeling from heartburn can go all the way up to your throat. You may be more likely to notice heartburn after smoking, drinking alcohol or coffee, or eating chocolate. It can also get worse when you bend over or when you’re lying down.

Other symptoms of hiatus hernia and GORD include:

  • Feeling sick or being sick
  • A cough or wheezing when breathing, especially at night – this is caused by breathing in the acid that has come up from your stomach
  • Mouth filling with saliva
  • Finding it difficult or painful to swallow
Tests to diagnose: 

Imaging tests are used to detect a hiatal hernia and any damage possibly incurred by acid reflux. One such diagnostic tool is a barium swallow X-ray, sometimes called an “upper GI.”

You’ll need to fast for eight hours prior to the test to ensure that the upper portion of your gastrointestinal tract (i.e. your esophagus, stomach, and part of your small intestine) is clearly visible on the X-ray.

Treatment: 

Treatment for hiatus hernia generally aims to ease the symptoms of acid reflux. The treatment you need will depend on how severe your symptoms are and how much they are affecting you.

Self-help

You can reduce the symptoms of a hiatus hernia and prevent further problems by making the following lifestyle changes.

If you’re overweight or obese, lose excess weight.

Eat small meals often and try not to eat just before you go to bed.

Giving up smoking and cutting down on alcohol will help.

Wear loose comfortable clothes.

Raise the head of your bed and try not to stoop or bend down.

Cut down or stop eating food or drinks that make your symptoms worse. See our frequently asked questions for more information.

Medicines

You can take medicines to help reduce the symptoms of reflux from a sliding hiatus hernia. The most common are antacids, which work by neutralising the acid in your stomach. How well antacids work varies from person to person. If you find they don’t relieve your symptoms, your GP or pharmacist may suggest a different medicine. The two main types that you may be prescribed are called H2 receptor antagonists and proton pump inhibitors. Both of these reduce the amount of acid produced by your stomach.

Surgery

If you have tried other treatments and they haven’t worked, or your symptoms are severe, your doctor may suggest an operation. You will also need to have surgery if a rolling hernia becomes strangulated.

There are a number of different types of operation to repair a hiatus hernia. They involve putting the gastro-oesophageal junction back into your abdomen and tightening up the hiatus (the opening).

Your surgeon will also strengthen the oesophageal sphincter by wrapping the stomach around it. The oesophageal sphincter is a bundle of muscles which stops what is in your stomach from coming back out. This operation is called a fundoplication and is usually done as a laparoscopic (keyhole) procedure.