AMITA Health Endoscopy Center Lincoln Park

Hiatal Hernia

Overview

A hiatal hernia is bulging of the upper part of the stomach upwards through an opening in the diaphragm. The diaphragm is the large muscle that separates your chest from your abdomen and helps with breathing.

The diaphragm has a necessary opening (hiatus) in it through which your esophagus passes before attaching to your upper stomach. The esophagus is the muscular tube that connects your mouth to your stomach. When a hiatal hernia occurs, the upper stomach protrudes upward through the diaphragm hiatus and into the chest cavity.

When only a small amount of the stomach bulges into the chest cavity, most patients exhibit no symptoms. The small hiatal hernia may be found on imaging studies while checking for other medical conditions. A large hiatal hernia may allow stomach acid to reflux (go backward) up into the esophagus and cause heartburn and chest pain.

Risk factors and causes for hiatal hernia include increased, persistent pressure in the abdomen (vomiting, lifting heavy weights or objects), injury in the area from previous surgery, obesity, being born with a large diaphragm hiatus, or just age-related weakening of the diaphragm.

Diagnosis of hiatal hernia can be established through several studies. Usually, an x-ray with barium swallowed can help, as can an upper gastrointestinal (GI) endoscopy. An endoscopy involves a tube with a camera that is lowered down into the esophagus to view the inner lining and sometimes take a tissue sample (biopsy). Esophageal manometry can also aid in the diagnosis. Manometry measures esophageal pressure and movement or motility in your esophagus.

Symptoms

  • Heartburn and chest pain
  • *Please seek immediate medical attention with chest pain, especially with arm pain or shortness of breath
  • Burning sensation in your throat or sour taste in your mouth from acid reflux
  • Trouble swallowing food (dysphagia)
  • Upper abdominal pain
  • Feeling full after eating a small amount of food
  • Black stools or vomiting blood from GI bleeding

Treatments

Acid suppressors. Acid-reducing medication will likely be prescribed by your provider. Stomach acid can irritate your esophageal lining. The most common medications to reduce acid are proton pump inhibitors or PPIs. Omeprazole (Prilosec) is an example of a PPI. Others include H-2 blockers such as cimetidine (Tagamet).

Surgery. Surgery for a hiatal hernia can be through a single chest incision (thoracotomy) or through a few small holes in your abdominal wall using a laparoscope. A laparoscope is a tube with a light, camera and several small tools. The goal of either approach is to pull the entire stomach back down through the diaphragm’s hiatus and make the hiatus smaller so that the hernia is unlikely to reoccur. Sometimes the lower esophageal sphincter, the muscular valve at the lower end of the esophagus, also needs to be reconstructed.

Prevention

Weight. Getting to and maintaining a healthy weight can help reduce symptoms.

Eating. Avoid lying down after a meal and eat several smaller meals throughout the day while watching portion size. Avoid alcohol, fatty foods, tomato sauce, chocolate, caffeine and certain other foods that can worsen your symptoms. Avoid any foods that typically trigger your heartburn.

Elevate the head of your bed. Many patients experience worsening of their symptoms at night. If so, elevating the head of your bed may help. A common way to achieve this is using a wedge between your box spring and mattress. Elevating your head at night can make gravity your friend by keeping acid in your stomach and out of your esophagus.

Stop smoking.