Dr. M.J. Bazos MD, Patient Handout
About Your Diagnosis
A hiatal hernia is a weakness or stretching of the opening where the esophagus passes through the diaphragm. The diaphragm is the muscle separating the chest from the abdomen. Because of the weakness or stretching, acid from the stomach may flow backward into the esophagus (the tube that connects the mouth and stomach) causing irritation. The stomach may also come through the opening into the lower chest. This condition can affect individuals of all ages, although it is more common in individuals older than 50 years. The cause of this condition is unknown; however, there are many factors that increase the risk including obesity, pregnancy, smoking, constant straining or lifting with tightened abdominal muscles, coughing, abdominal trauma, and chronic constipation or straining with bowel movements. Endoscopy, using a small light tube with a tiny video camera on the end, or a barium swallow xray are used to detect a hiatal hernia. Pressure measurements (manometry) may be done to prove a reduced pressure at the esphagogastric junction.

Living With Your Diagnosis
Symptoms generally occur about an hour after meals. Symptoms include heartburn, chest pain, belching, and rarely swallowing difficulties. Bending over or lying down can make the heartburn worse. A possible complication of a hiatal hernia is bleeding, caused by irritation of the esophagus. However, frequently individuals with a hiatal hernia are symptom free.

The treatment of a hiatal hernia is designed to control the symptoms and to prevent complications. The main treatment options are lifestyle and diet modifications along with antacids. To help keep stomach acid away from the hernia, raise the head of your bed 4–6 inches. Use wooden blocks or bricks to do this. You should not use 2 or 3 pillows to elevate your head. You should avoid foods and drinks that aggravate the symptoms. Antacids are most effective when taken on a regular schedule. Suggested dosing schedules for antacids are 1–2 hours after meals and at bedtime, or 1 hour before meals and at bedtime. If constipation is a problem, stool softeners can be taken. If the symptoms cannot be controlled, or complications such as scarring, ulceration, or strangulation (twisting in a way that cuts off the blood supply)
are occurring, surgery to correct the hernia may be necessary.

The DOs
• Lose weight if overweight.
• Eat slowly.
• Eat four or five small meals a day.

The DON’Ts
• Avoid alcoholic drinks and caffeine products (coffee, tea, cocoa, cola drinks).
• Avoid fried, spicy, and fatty foods, citrus juices, peppermint, and spices that aggravate the symptoms of hiatal hernia.
• Avoid large meals.
• Do not eat anything for at least 2 hours before bedtime.
• Do not bend over or lie down immediately after eating.
• Do not smoke.
• Avoid tight fitting pants, belts, and undergarments.
• Do not strain during bowel movements, urination, or lifting.

When to Call Your Doctor
• If you have the sensation that food stops beneath the breastbone.
• If you have pain that happens with shortness of breath, sweating, or nausea.
• If you vomit blood or have recurrent vomiting.
• Symptoms do not improve after 1 month of treatment.

National Digestive Diseases Information Clearinghouse