Hiatus hernia

A hiatus hernia occurs when one of the organs in your abdomen (tummy) pushes up into your chest area through a hiatus (opening) in your diaphragm.

• Your diaphragm is a large thin muscle between your chest and abdomen. 
• Most often, the organ that pushes through the diaphragm to create a hiatus hernia is your stomach, but it can also be your pancreas, spleen or small intestine.
• A hiatus hernia has different causes, symptoms and treatment to an abdominal hernia.
• A hiatus hernia is a common problem. Some studies suggest that up to half of people having tests for indigestion have a hiatus hernia. It occurs more often in men.
• Although you may have a hiatus hernia with no symptoms, it can lead to gastro-oesophageal reflux or GORD. Nearly all patients with severe GORD have a hiatus hernia.
• It's rare for a hiatus hernia to cause problems, but long-term damage to your oesophagus (the tube connecting mouth and stomach) caused by leaking stomach acid can lead to ulcers, scarring and changes to the cells of your oesophagus. This can increase your risk of oesophageal cancer.

Causes

A hiatus hernia tends to occur from your diaphragm weakening as you age or from too much pressure being put on your abdomen. This means those people most likely to get a hiatus hernia are:

• pregnant
• obese, or
• over 50 years of age.

Although a hiatus hernia doesn’t cause symptoms, it may affect how well some parts of your body (eg, your sphincter muscle and diaphragm) work to stop stomach acid from refluxing (going back up) into your oesophagus.

This refluxed acid can cause irritation of the lower part of your oesophagus, which can mean you may:

• feel heartburn (a burning feeling from your stomach up to your throat)
• have pain in your upper abdomen and chest
• get an acid taste in your mouth
• burp
• have difficulty swallowing.

Image credit: Adapted from Bruce Blaus Wikimedia Commons

Diagnosis

If you have the symptoms listed above, see your healthcare provider. Hiatus hernias can usually be diagnosed by an X-ray or an endoscopy.

Treatment

If you're having symptoms, the best treatment is to make lifestyle changes (see below), and, if necessary, take medicine. Surgery is usually only recommended if other treatments haven't worked.

Medicines

Medicines are often used to relieve the symptoms of hernia such as heartburn or GORD. They do not treat the hernia itself. Examples of commonly used medicines include:

• Antacids such as Alu-tab®, Chewy Quick-Eze®, Mylanta P®. These usually contain magnesium or aluminium and work by neutralising (weakening) the acid in your stomach, which can reduce the symptoms of heartburn and relieve pain. Read more about antacids.
• H2-receptor blockers such as ranitidine and famotidine. These reduce stomach acid and relieve indigestion, pain and discomfort. They are slower acting than antacids but provide longer-term symptom relief. Possible side effects may include diarrhoea, headaches, tiredness and a rash.
• Proton pump inhibitors (PPIs) such as omeprazole and lansoprazole. These block stomach acid production and help to heal your oesophagus. Side effects can include headaches, diarrhoea (runny poo), nausea (feeling sick0 or constipation. Read more about proton pump inhibitors.

You can help yourself by making the following lifestyle changes:

• Eat smaller meals more often, rather than 3 large meals a day.
• Avoid lying down (including going to bed) for 3 hours after eating or drinking.
• Don’t dig the garden or lift or move heavy objects soon after eating.
• Avoid eating or drink anything that makes your symptoms worse, eg, hot, spicy or acid forming food, or fizzy drinks. Acid forming foods include meat, rice, pasta, bread, cheese, soft drinks, alcohol, coffee and sugar.
• Lose extra weight.
• Avoid tight clothing around your stomach.
• Raise the head end of your bed.
• Quit smoking.
• Reduce your intake of caffeine and alcohol.