How a Hiatal Hernia Is Treated

A hiatal hernia may be treated with medication to relieve symptoms or, in some cases, surgery to repair the hernia.

The condition occurs when part of the lower esophagus (the tube that runs from the mouth into the stomach) pokes into the chest through the diaphragm. This can interfere with the lower esophageal sphincter (LES), which prevents stomach contents from re-entering the esophagus. It can lead to heartburn and gastroesophageal reflux disease (GERD).

For most people, medications can help relieve mild heartburn from GERD. Lifestyle modifications, including diet changes or weight loss, also help. However, if the hernia is large, causing an obstruction, or cutting off blood flow, surgery may be recommended.

This article discusses how hiatal hernias are treated, including at-home lifestyle changes and medications to improve your symptoms. It also covers what procedures are available for more serious cases.

Home Remedies and Lifestyle

Hiatal hernia and GERD are more common in people who are over age 50, smokers, or those affected by obesity. This may be due to excessive stress on the stomach (in the case of obesity) or weak supporting tissue between the esophagus and stomach.

To overcome reflux symptoms, you need to address the underlying causes. There are several key lifestyle changes that can help minimize your symptoms:

• Weight loss relieves the abdominal pressure that can cause a hernia. It won’t necessarily reverse it. However, it may prevent a mild hernia from developing into a more serious type of hiatal hernia called a paraesophageal hernia. This is the type of hernia associated with an increased risk of GERD.
• A low-fat, high-fiber diet not only contributes to weight loss but can also help normalize bowel function. Constipation—and straining to have a bowel movement—can put stress on muscles and contribute to herniation. In contrast, foods consumed as part of a high-fat diet are more likely to stimulate acid to break down the excess fats and simple carbohydrates.
• Proper hydration, namely drinking no fewer than eight glasses of water per day, can further reduce the risk of constipation while diluting concentrations of acid in the stomach.
• Avoiding trigger foods can provide relief whatever your age or weight. Common triggers include red meat, fried foods, spicy foods, whole-fat dairy, tomato-based sauces, citrus, carbonated drinks, caffeine, alcohol, and excessive salt. By contrast, "safe" foods such as lean chicken, fish, low-fat dairy, grains, and vegetables can help ease reflux symptoms.
• Quitting cigarettes is a must if you are struggling with heartburn. While smoking does not cause a hiatal hernia, it can relax an already weakened LES and allow food and acid to reflux more easily. This is why smokers often experience heartburn immediately after lighting up or why they are far more likely to develop GERD than non-smokers.

Over-the-Counter Medications

Over-the-counter (OTC) medication is a first-line defense against heartburn and acid reflux that occur with hiatal hernias. Some of the more commonly used medications include antacids, Histamine 2 (H2) receptor blockers, and proton pump inhibitors (PPIs).

These medicines can be helpful in reducing symptoms as you work on addressing the root cause of your reflux and take steps to make lifestyle changes.

Antacids

Antacids work by neutralizing stomach acid with ingredients like aluminum hydroxide and magnesium hydroxide. Common brands include:

• Tums
• Rolaids
• Gaviscon

Overuse of antacids can lead to constipation (from magnesium-based antacids) or diarrhea (from aluminum-based antacids). 

H2 Receptor Blockers

H2 receptor blockers reduce the production of stomach acids, which can minimize reflux. H2 blockers available over the counter include:

• Pepcid (famotidine)
• Tagamet (cimetidine)
• Zantac 360 (famotidine)

Side effects include constipation, diarrhea, dry mouth, headaches, and ringing in the ears (tinnitus).

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) offer similar action to H2 blockers but are stronger and faster. They include Nexium (esomeprazole), Prevacid (lansoprazole), Pantoprazole (protonix), and Prilosec (omeprazole). PPIs are more typically used if an H2 blocker fails to provide relief.

Common side effects are similar to those of H2 receptor blockers and include headache, constipation, diarrhea, and flatulence.

Prescriptions

If OTC medications aren't effective in relieving your heartburn symptoms, you may need a stronger version. Your healthcare provider will determine whether a prescription-strength H2 blocker or PPI is an option for you.

In addition to stronger versions of OTC medications, your healthcare provider may also consider a PPI medication available only by prescription, such as:

• Protonix (pantoprazole)
• Aciphex (rabeprazole)
• Dexilant (dexlansoprazole)

Surgeries

Surgery for a hiatal hernia is only indicated if it has turned into a paraesophageal hernia and is causing symptoms that cannot be treated with medications or lifestyle changes. A paraesophageal hernia occurs when a hiatal hernia worsens and larger portions of the stomach begin to enter the chest cavity.

It also can be considered with sliding hernia if it's associated with GERD.

A paraesophageal hernia has an increased risk of serious complications. These include volvulus (a condition where the stomach twists more than 180 degrees) and strangulation (where blood circulation is cut off). Both are considered medical emergencies.

If you have a large hernia, the type of surgery needed to repair it will largely be determined by the nature and severity of the complication.

Open or Laparoscopic Repair

Either a transthoracic ("open") or transabdominal (laparoscopic, or "keyhole") surgery may be used to repair a paraesophageal hernia.

• Open surgery involves entry into the body through an incision, usually on the left side of the body. It is more commonly used in emergency situations where there is severe bleeding or an organ rupture. It may also be used in non-emergency situations, such as when the entire stomach has slipped into the chest cavity (known as an intrathoracic stomach).
• Laparoscopic surgery involves the insertion of multiple surgical instruments into three more keyhole-sized incisions in the abdomen. For non-emergency situations, it is considered just as effective as a transthoracic surgery but with far fewer complications and quicker recovery time.

Nissen Fundoplication

Nissen fundoplication is a newer technique performed laparoscopically. The aim of the surgery is to tightly wrap the upper part of the stomach (called the fundus) around the esophagus and secure it in place with stitches or staples so that it's held upright and supported.

If performed correctly, fundoplication can realign the LES into a position where it functions normally.

Bloating, vomiting, burping, and difficulty swallowing are common postoperative side effects that tend to resolve on their own within two to four weeks.

Hiatal Hernia Doctor Discussion Guide

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Complementary and Alternative Medicine (CAM)

In addition to antacids and acid-blockers, some complementary therapies may provide some relief of acute reflux symptoms.

Licorice

Licorice, derived from the licorice root, has long been used to treat heartburn and other gastrointestinal symptoms. While research remains lacking, some studies have suggested that it has its place alongside traditional acid-blocking medications.

Licorice tea is one of the more common forms used. Another, known as deglycyrrhizinated licorice (DGL), is available as a nutritional supplement and may be more tolerable due to the removal of glycyrrhizin (a substance known to lower blood potassium levels).

Ginger

Ginger is another popular option that may help alleviate heartburn symptoms. Ginger root is rich in antioxidants and contains compounds believed to reduce gastric contractions and, thus, lessen the likelihood of acid reflux.

However, if used in excess, ginger may have the opposite effect.

Ginger can be purchased as a tea or in powder, capsule, or liquid formulations.

As with any CAM options, it's best to discuss licorice and ginger with your healthcare provider before trying them.

Summary

A hiatal hernia is a common condition that can cause heartburn and other GERD-like symptoms. Your healthcare provider may suggest lifestyle changes, OTC antacids, or prescription medications to reduce your symptoms.

For a more severe case, known as paraesophageal hernia, surgery may be needed to prevent serious complications.