Endoscopy involves inserting a long, flexible tube (endoscope) down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum).
A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. 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 lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine.
- Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach and check for inflammation.
- Esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus.
Most people with a hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.
If you experience heartburn and acid reflux, your doctor may recommend:
- Antacids that neutralize stomach acid. Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
- Medications to reduce acid production. These medications — known as H-2-receptor blockers — include cimetidine (Tagamet), famotidine (Pepcid) and nizatidine (Axid). Stronger versions are available by prescription.
- Medications that block acid production and heal the esophagus. These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec, Zegerid). Stronger versions are available in prescription form.
Sometimes a hiatal hernia requires surgery. Surgery is generally used for people who aren't helped by medications to relieve heartburn and acid reflux, or have complications such as severe inflammation or narrowing of the esophagus.
Surgery to repair a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing an esophageal sphincter or removing the hernia sac.
Or your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).
Sometimes surgery is done using a single incision in your chest wall (thoracotomy).
Lifestyle and home remedies
Making a few lifestyle changes may help control the symptoms and signs caused by a hiatal hernia. Try to:
- Eat several smaller meals throughout the day rather than a few large meals
- Avoid foods that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine
- Avoid lying down after a meal or eating late in the day
- Eat at least two to three hours before bedtime.
- Maintain a healthy weight
- Stop smoking
- Elevate the head of your bed 6 inches (about 15 centimeters)
Preparing for your appointment
You'll probably see a family doctor or general practitioner.
If you've been diagnosed with a hiatal hernia and your problems persist after you make lifestyle changes and start medication, you might be referred to a doctor who specializes in digestive diseases (gastroenterologist).
What you can do
- Be aware of any pre-appointment restrictions, such as restricting your diet before your appointment.
- Write down any your symptoms, including any that may seem unrelated to the reason why you scheduled the appointment.
- Make a list of all medications, vitamins and supplements you're taking.
- Write down key medical information, including other conditions.
- Write down key personal information, including any recent changes or stressors in your life.
- Write down questions to ask your doctor.
- Ask a relative or friend to accompany you, to help you remember what the doctor says.
Questions to ask your doctor
- What caused my hiatal hernia?
- What tests do I need? Is there any special preparation for them?
- Will I need treatment? What are my options, and the benefits and risks of each?
- I have other health problems. How can I best manage these conditions together?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may leave time to go over points you want to spend more time on. You may be asked:
- When did you begin experiencing symptoms? How severe are they?
- Have your symptoms been continuous or occasional?
- What, if anything, appears to improve or worsen your symptoms?