A hiatus hernia, sometimes known as a hiatal hernia, is different from an abdominal wall hernia. Unlike an abdominal (or groin) hernia, a hiatus hernia occurs in the chest area and affects the digestive system. It occurs when part of the stomach pushes up through the diaphragm into the chest via the hiatus, the natural opening where the oesophagus (gullet) passes from the mouth to the stomach.
This hiatus causes a narrowing of the opening into the stomach and this helps prevent stomach contents from going the wrong way, i.e. upwards, which is called reflux.
Hiatus Hernia Symptoms
If the area of the hiatus is weak, the function of clamping down on the entry to the stomach is weakened, the result being the reflux of acidic digestive juices up into the oesophagus, which is not protected against the action of these acids. The outcome of this is often a quite painful burning sensation. Should reflux occur in one’s sleep, there is a real risk of aspirating the acid mixture (‘breathing’ it in to the lungs) which can have a devastating outcome – we will come back to that below. Other symptoms patients suffer from severe chest pain which may extend to just below the shoulder blades.
At its worst, hiatus hernia pain can mimic that of a heart attack. It is not uncommon for patients to arrive at a hospital Emergency Department (A&E) with a suspected heart attack and only after professional tests is the the cause revealed. To describe this as ‘distressing’ is an understatement.
Unlike an abdominal hernia, there are no tell-tale visible symptoms of hiatus hernia, as the whole event occurs inside the chest. The diagnosis is established by a specialist; the combination of symptoms must be confirmed by X-ray and an endoscopy (a view using a lighted tube).
As mentioned above, another troubling effect of reflux is that the acidic stomach contents can rise up the oesophagus as far as the throat. The throat area, of course is where the trachea (‘windpipe’) and the oesophagus (‘gullet’) come together. This has two common consequences. One is that awful taste of vomit (which is, of course, what it is). However, a more serious consequence that can happen is aspiration (‘breathing in’) the acidic liquid of the reflux. The body is extremely sensitive to anything other than a gas (like air) entering the lungs so the acid triggers an instant reflex reaction. At its mildest that would be a coughing fit to clear the airway. At its worst, it can actually choke the sufferer, with the windpipe going into spasm and choking off all the airflow into the lungs. Another manifestation of this problem is a long-term cough.
What can be done to avoid a hiatus hernia?
Whilst there is nothing that one can do to prevent the occurrence of a hiatus hernia, there are three ways of dealing with the symptoms.
1. Lifestyle
If you notice that certain foods trigger your symptoms while others do not, simply avoiding those trigger foods can significantly reduce discomfort. It is also sensible to avoid heavy meals before activities that involve bending, such as gardening, as well as lifting or moving heavy objects, as these can worsen symptoms. In many cases, adjusting the timing of meals and physical activity can help prevent flare-ups. However, for some people, even drinking a glass of water before lying down may cause prolonged discomfort.
To help manage symptoms, it can be beneficial to avoid eating or drinking for a suitable period before going to bed. Eating smaller meals more frequently, rather than large meals, may also provide relief.
Making small adjustments to your sleeping position can further reduce reflux. Slightly elevating the head of the bed, such as by placing blocks under the bedposts, creates a gentle incline that allows gravity to help keep stomach contents down. As with many conditions, the issue is often mechanical and can sometimes be improved with simple practical measures.
The main advantage of adopting lifestyle changes is the potential to manage symptoms without the need for medication or surgery. However, this approach may not work for everyone, and the adjustments required can sometimes feel restrictive or difficult to maintain.
2. Medicine
There are several different medicines available to deal with the symptoms of hiatus hernia. They work in different ways, but are normally of an antacid type, and some work better on certain patients and others better on other patients. You should ask your doctor to suggest one or other type and, if that does not help, he may suggest a different one.
An important note here about medicines. Chronic (long-term) indigestion should ALWAYS be referred to your doctor. We do not recommend you choose your own medication, even over-the-counter. Only your doctor will be able to properly assess what you need.
The advantage of the medicinal approach is that, in certain cases, this allows the patient to avoid all symptoms without too much inconvenience. The disadvantage is that it may not be desirable to take medicine for the rest of their life.
3. Surgery
The surgery for hiatus hernia should not be confused with the techniques described for abdominal wall hernias. The surgical procedures are different.
We would say that no decision should be taken to proceed to surgery for hiatus hernia lightly. A proper specialist diagnosis is essential.
For many cases of hiatus hernia, it is perfectly possible to end the problem once and for all by a procedure which makes a stronger ‘valve’ function. This is accomplished by tightening the hiatus area in order to keep the stomach in its correct place below the diaphragm, and which reinstates the correct opening into the stomach, preventing the reflux and other symptoms.
At The British Hernia Centre, we effect the procedure through tiny incisions using a ‘keyhole’ technique. The patient is admitted to hospital for usually no more than one night, followed by a recuperation period of about a week. After this time, most patients are able to get back to virtually their normal routine without any of the symptoms of the hiatus hernia.
Despite the very high success rate of this operation, we follow the following important steps before planning the procedure:
- Confirming the correct diagnosis
- Ensuring that the patient has tried the alternative methods of lifestyle and medicine
General tips
There are several foods and other matters that are commonly associated with aggravating the symptoms. Before considering medicines or surgery, it is often worthwhile making changes to avoid such things as:
- Hot (too hot) foods and drinks
- Spicy foods
- Acidic and acidifying foods
- Fizzy drinks & fruit juice
- Foods which are difficult to digest
- Smoking
- Alcohol
- Being overweight
- ANYTHING that gives you heartburn / indigestion
We are asked:
Q: “Is antacid medication likely to work in the long term because nothing I take makes any difference to the discomfort and pain. I wake up with acid in my throat which is horrible and I take medication, but it does not go away. Do antacids really make any difference once a hiatal hernia has developed?”
A: Antacids are used to treat symptoms, not the cause. By the time you feel the need to take them, damage has been done by the very act of burning you. At worst, acid reflux, especially in your sleep can have the worst imaginable outcome. Antacids are wonderful, but in most cases, are NOT the long-term answer.
What to do next
We advise people who contact us from all over the world that the best course of action is to have the endoscopy and x-ray tests performed locally and then contact us to advise the most appropriate treatment, including surgery (if that is what is required). Your own family physician should be able to arrange the necessary ‘basic’ tests.
If those tests indicate that a hiatus hernia exists, then contact The British Hernia Centre with those results and we will be happy to advise on how best to proceed.
For a completely free, personal opinion on your own hiatus hernia, give us some key details here. We will consider what you tell us and get back to you with our opinion. There is no obligation whatsoever and of course, it is confidential.