Diagnosis

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or pain in the chest or upper abdomen. These tests or procedures include:

• X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that coats and fills the inside of your digestive tract. The coating allows your health care professional to see an outline of your esophagus, stomach, and upper intestine.
• A procedure to look at the esophagus and stomach, called endoscopy. Endoscopy is a procedure to examine your digestive system using a long, thin tube with a small camera, called an endoscope. The endoscope is passed down your throat and looks at the inside of your esophagus and stomach and checks for inflammation.
• A test to measure muscle contractions of the esophagus, called an esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force used by the muscles in your esophagus.

Treatment

Most people with a hiatal hernia experience no symptoms and do not need treatment. If you experience symptoms, such as frequent heartburn and acid reflux, you may need medication or surgery.

Medicines

If you experience heartburn and acid reflux, your healthcare professional may recommend:

• Antacids that neutralize stomach acid. Antacids can provide quick relief. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
• Medicines to reduce acid production. These drugs are known as H-2 receptor blockers. They include cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR). Stronger versions are available on prescription.
• Medicines that block acid production and heal the esophagus. These drugs are known as proton pump inhibitors. They are stronger acid blockers than H-2 receptor blockers and allow time for damaged esophageal tissue to heal. Proton pump inhibitors available without a prescription include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec, Zegerid). Stronger versions are available by prescription.

Surgery

Sometimes a hiatal hernia requires surgery. Surgery can help people who are not helped by medication to relieve heartburn and acid reflux. Surgery can also help people who have complications such as severe inflammation or narrowing of the esophagus.

Surgery to repair a hiatal hernia may involve pulling the stomach down into the abdomen and making the opening in the diaphragm smaller. Surgery may also involve reshaping the muscles in the lower esophagus. This helps prevent the contents of the stomach from coming back up. Sometimes hiatal hernia surgery is combined with weight loss surgery, such as a sleeve gastrectomy.

Surgery can be performed using a single incision in the chest wall, called a thoracotomy. Surgery can also be performed using a technique called laparoscopy. In laparoscopic surgery, a surgeon inserts a tiny camera and special tools through several small incisions in the abdomen. The operation is then performed by a surgeon who sees images from inside the body displayed on a video monitor.

Lifestyle and home remedies

Making a few lifestyle changes can help control the symptoms caused by a hiatal hernia. Try to:

• Eat several smaller meals throughout the day instead of a few large meals.
• Do not eat foods that trigger heartburn. These include fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onions and caffeine.
• Avoid lying down after a meal or eating late in the day.
• Maintain a healthy weight.
• Stop smoking.
• Raise the head of your bed 8 inches (20 centimeters).

Preparation for your appointment

Make an appointment with a doctor or other healthcare professional if you have symptoms that worry you.

If you’ve been diagnosed with a hiatal hernia and your problems persist after you make lifestyle changes and start medication, you may be referred to a doctor who specializes in digestive disorders, called a gastroenterologist.

Because appointments can be short, it’s a good idea to be prepared. Here is some information to help you get ready.

What you can do

• Be aware of any restrictions before making an appointment. At the time you make the appointment, be sure to ask if there is anything you need to do beforehand, such as restricting your diet.
• Write down symptoms you experience, including any that may seem unrelated to the reason you scheduled the appointment.
• Write down important personal information, including heavy loads or recent life changes.
• Make a list of all medicines, vitamins or supplements you take and the dosages.
• Bring a family member or friend. Sometimes it can be difficult to remember all the information provided during an agreement. Someone accompanying you might remember something you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your doctor or other healthcare professional is limited, so making a list of questions can help you make the most of your time together. List your questions from most important to least important if time is running out. For hiatal hernias, some basic questions to ask include:

• What is likely causing my symptoms?
• What are the possible causes of my symptoms other than the most likely cause?
• What tests do I need?
• What is the best course of action?
• What are the alternatives to the primary approach you suggest?
• I have these other health conditions. How can I best handle them together?
• Are there any restrictions I must follow?
• Should I see a specialist?
• Are there brochures or other printed material I can have? Which websites do you recommend?

Please do not hesitate to ask other questions.

What you can expect from your doctor

Be prepared to answer questions such as:

• When did your symptoms start?
• Have your symptoms been persistent or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, seems to worsen your symptoms?