Hiatal Hernia

Diagnosis

A hiatal hernia is often discovered during tests or procedures performed to find the cause of heartburn, chest pain, or discomfort in the upper abdomen. These diagnostic tests help visualize the digestive system and identify the presence of a hernia.

Common diagnostic methods include:

• X-ray of the upper digestive system: After drinking a chalky liquid that coats the digestive tract, X-rays are taken to show the outline of the esophagus, stomach, and upper intestine.

• Endoscopy: This procedure uses a long, thin tube with a camera (endoscope) to examine the inside of the esophagus and stomach for inflammation or other abnormalities.

• Esophageal manometry: This test measures the muscle contractions of the esophagus during swallowing, as well as the coordination and strength of those muscles.

These tests help determine the size of the hernia and assess any related complications, such as acid reflux or inflammation.

Treatment

Most people with a hiatal hernia do not experience symptoms and do not need treatment. However, if symptoms such as frequent heartburn or acid reflux occur, medical or surgical treatment may be necessary.

Medicines used to treat hiatal hernia symptoms include:

• Antacids that neutralize stomach acid, providing quick relief. Overuse may cause side effects like diarrhea or kidney issues.

• H-2-receptor blockers, such as cimetidine, famotidine, or nizatidine, which reduce acid production. Stronger forms are available with a prescription.

• Proton pump inhibitors, such as lansoprazole or omeprazole, which block acid production more effectively and allow the esophagus to heal. Prescription-strength versions are available for more severe cases.

Surgery may be recommended when:

• Symptoms persist despite medication.

• There are complications such as inflammation or narrowing of the esophagus.

Surgical repair may involve pulling the stomach back into the abdomen, tightening the diaphragm opening, and reshaping the lower esophageal muscles to prevent acid reflux. In some cases, hiatal hernia surgery is performed along with weight-loss procedures such as sleeve gastrectomy.

Surgery can be done through:

• A single incision in the chest wall, known as thoracotomy.

• Laparoscopic surgery, which involves several small incisions in the abdomen. A tiny camera and instruments are used to perform the operation while the surgeon views the inside of the body on a video monitor.

With appropriate diagnosis and treatment, most people with a hiatal hernia can effectively manage symptoms and maintain a healthy quality of life.