Hiatal Hernias

What are hiatal hernias?

When an internal body part pushes into another area of the body, it is called a hernia. Common hiatal hernias – often called “sliding” hiatal hernias – occur when the upper stomach moves from the abdominal cavity through the diaphragm, over the lower part of the esophagus, and up into the chest cavity.

Symptoms

Hiatal hernias are more common in people 50 years and older. Signs and symptoms can include:

  • Acid reflux – backflow of stomach acid into the esophagus
  • Chest pain, often centrally located and unresponsive to antacids
  • Dysphagia – difficulty eating or swallowing, or the impression of food sticking in the chest area
  • No response to gastroesophageal reflux disease (GERD) medication
  • Persistent heartburn – a burning or pressure sensation behind or below the breastbone
  • Regurgitation of food or liquids into the mouth, which can include a bitter or acid taste
  • Upper abdominal pain
  • Vomiting of blood or passing of black stools

Diagnosing

Your doctor may suspect a hernia based on your medical history and your signs and symptoms, and may refer you to a gastroenterologist. Tests and procedures used to diagnose a hiatal hernia include:

X-ray of your upper digestive system: You may be asked to drink a liquid that coats the inside of your digestive tract to allow your doctor to see a silhouette of your esophagus, stomach and upper intestine.

Upper endoscopy: A small tube with a camera is inserted through your mouth and throat to examine the inside of your esophagus and stomach to check for inflammation.

Treating Hiatal Hernias

Hiatal hernias may be treated with medication, surgery or lifestyle changes.

Dietary and Lifestyle Changes

Your doctor will review your symptoms with you and may recommend you:

  • Avoid large meals and certain foods and drinks that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion and caffeine
  • Eat several hours before sleeping and avoid lying down after a meal
  • Elevate the head of your bed by 30 degrees by using a block under the bed or a wedge pillow
  • Stop smoking
  • Lose weight

Medications

  • Antacids: Over-the-counter antacids and their prescriptive counterparts may provide quick relief of symptoms by neutralizing stomach acid.
  • H-2-receptor blockers: To reduce acid production and provide longer relief of your symptoms, your doctor may prescribe cimetidine, famotidine, nizatidine or ranitidine.
  • Proton pump inhibitors (PPIs): Your doctor may prescribe a PPI to block acid production and heal the esophagus.

Surgery

When medications do not relieve heartburn and acid reflux, or if complications such as severe inflammation or narrowing of the esophagus arise, surgery may be required. Virginia Mason’s esophageal surgery team will carefully review which surgical approach is best for you, including the possibility of minimally invasive surgery. The aims of surgery may include pulling your stomach back down into your abdomen, decreasing the size of the opening in your diaphragm, reconstructing an esophageal sphincter or removing the hernia sac. 

To schedule an appointment with Virginia Mason's Gastroenterology Department, call (206) 223-2319.