A hiatus hernia occurs when part of the stomach pushes upward through the diaphragm. The diaphragm normally has a small opening (hiatus) through which the food tube (esophagus) passes on its way to connect to the stomach. The stomach can push up through this opening and causes a hiatus hernia.
In most cases, a small hiatus hernia doesn't cause problems, and one may never know that he/ she has a hiatus hernia unless the doctor discovers it when checking for another condition.
But a large hiatus hernia can allow food and acid to back up into the esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatus hernia sometimes requires surgery.

Symptoms :

Most small hiatus hernias cause no signs or symptoms. However, larger hiatus hernias can cause signs and symptoms such as:
  • Heartburn
  • Regurgitation of food
  • Difficulty in swallowing
  • Chest or abdominal pain
  • Feeling especially full after meals

Causes :

A hiatus hernia occurs when weakened muscle tissue allows the stomach to bulge up through your diaphragm. The pressure on the stomach and age-related changes in the diaphragm may contribute to the formation of a hiatus hernia.

Tests and diagnosis :

A hiatus hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. Such tests or procedures include:
  • An esophagogram (barium swallow). During this procedure, patient drinks a chalky liquid containing barium that coats the upper digestive tract. This provides a clear silhouette of the esophagus, stomach and the upper part of the small intestine (duodenum) on an X-ray.
  • Endoscopy. During an endoscopy exam, the doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down the throat of the patient and into the esophagus and stomach to check for inflammation.
  • Manometry. During this test, a thin, pressure-sensitive tube (catheter) is passed through the nose, down through the esophagus and into the stomach. The catheter then measures pressure and movement inside the esophagus.

Treatments and drugs :

Most people with a hiatus hernia don't experience any signs or symptoms and won't need treatment. If one experiences signs and symptoms, such as recurrent heartburn and acid reflux, he/she may require treatment, which can include medications or surgery.

Medications for heartburn :

If patient experience heartburn and acid reflux, the doctor may recommend medications, such as Antacids that neutralize stomach acid, medications to reduce acid production, or medications that block acid production and heal the esophagus.

Surgery to repair a hiatus hernia :

In a small number of cases, a hiatus hernia may require surgery. Surgery is generally done laparoscopically. It is done for people who aren't helped by medications to relieve heartburn and acid reflux.
An operation for a hiatus hernia may involve pulling the stomach down into the abdomen and making the opening in the diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.
Laparoscopic surgery is a preferred method through 4 small incisions taken on abdominal wall. Patient generally is discharged from hospital in 2-3 days.

Selfcare and home remedies :

Making a few lifestyle changes may help control the signs and symptoms of acid reflux caused by a hiatus hernia.
  • Eat several smaller meals throughout the day rather than a few large meals.
  • Avoid foods that trigger heartburn, such as chocolate, onions, spicy foods, citrus fruits and tomato-based foods.
  • Avoid alcohol.
  • Eat at least two to three hours before bedtime.
  • Lose weight if you're overweight or obese.
  • Stop smoking.
  • Elevate the head of your bed 6 inches (about 15 centimeters).