Hiatal Hernia

The diaphragm is a thin sheet of muscle that runs across the top of the stomach. The small opening in the diaphragm where the food pipe (esophagus) and stomach meet is called the hiatus. When you eat, the muscle around the hiatus relaxes to let food pass from the esophagus into the stomach. The hiatus tightens to keep food and acid in the stomach.

In some people, the hiatus is too large or the muscle around it is weak. Then the top of the stomach can push upward through the hiatus. This is called a hiatal hernia. A hiatal hernia can let stomach acid flow back up the esophagus. This is called acid reflux.

Hiatal hernias are common. You may also hear them called diaphragmatic hernias. The cause of a hiatal hernia is not certain, but some things may make it more likely. These may include obesity, pregnancy, and vomiting or coughing.

Many people with hiatal hernia don't have symptoms. Often the symptoms are like those of GERD (gastroesophageal reflux disease or acid reflux). They can include:

  • Burning feeling under the breastbone (heartburn)

  • Other mild chest pain

  • Frequent burping

  • Food coming back up into the throat or mouth

  • Acid taste in the mouth

  • Trouble swallowing food or liquid

  • Nighttime choking, coughing, or wheezing

  • Feeling full after eating only a small amount of food

  • Nausea and vomiting

Treatment can reduce symptoms. This includes medicines and lifestyle changes. In severe cases, you may need surgery to tighten the hiatus.

Home care

Medicines help control symptoms, but they can't fix the hernia. 

  • Antacids help neutralize the normal acids in your stomach. You may find one works better than another for you. 

  • Acid blockers (H2 blockers) decrease acid production. 

  • Acid inhibitors (PPIs) decrease acid production in a different way than the blockers. 

  • Don't take nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen. These may worsen symptoms in some people. If you are taking these medicines for another health problem, talk with your healthcare provider before stopping them.

Lifestyle changes are important in treating your symptoms. You can help reduce or ease your symptoms if you:

  • Stop smoking and using tobacco. Also if possible, stay away from secondhand smoke.

  • Lose excess weight. Excess weight puts pressure on the stomach and esophagus.

  • Symptoms can be worsened by certain foods. Limit or stay away from fatty, fried, and spicy foods, as well as coffee, chocolate, and mint. Also stay away from foods with high acid content. These include tomatoes and citrus fruit and juices (orange, grapefruit, lemon). 

  • Eat smaller amounts at a time. Don't get overfull.

  • Don't use alcohol, caffeine, or tobacco. They can delay healing and worsen your symptoms.

  • If you get symptoms overnight, prop up the head of your bed. For instance, use 2 bed risers under the frame, at the head of the bed. Or use a wedge pillow to raise (elevate) your head.

Follow-up care

Follow up with your healthcare provider. Regular visits may be needed to check on your health. Be sure to take any medicines as prescribed and keep all your appointments. In some cases, you may need surgery to stop symptoms. Your healthcare provider will talk with you about this option if needed.

When to get medical advice

Call your healthcare provider right away if any of these occur:

  • Severe pain in your chest or belly (abdomen)

  • Can’t keep down food or liquid

  • Symptoms get worse

  • Other symptoms as indicated by your healthcare provider

Call 911

Call 911 if any of these occur:

  • Trouble breathing or swallowing

  • Worsening chest pain, especially if different from normal

  • Vomiting blood

  • Large amounts of blood in stool

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