Friendly Print preview

... see also Heartburn

Hiatus Hernia

What is a hiatus hernia?

A hiatus hernia occurs when the upper part of the stomach, which is joined to the oesophagus (gullet), moves up into the chest through the hole (called a hiatus) in the diaphragm. It is common and occurs in about 10 per cent of people.

What are the symptoms?

Most people are not troubled by their hiatus hernia, but if reflux of the acid contents of the stomach occurs (called gastro-oesophageal reflux), you get heartburn. This is a painful burning sensation in the chest, which can sometimes be felt in the throat. Sudden regurgitation of acid fluid into the mouth can occur, especially when you lie down or bend forward. These symptoms are a problem when you go to bed and can wake you up. Other symptoms include belching, pain on swallowing hot fluids and a feeling of food sticking in the oesophagus.

Who gets a hiatus hernia?

It is most common in overweight middle-aged women and elderly people. It can occur during pregnancy. The diagnosis is confirmed by barium meal X-rays or by passing a tube with a camera on the end into the stomach (gastroscopy).

What are the risks?

Hiatus hernia is usually not serious; however, it can cause inflammation of the lower end of the oesophagus. This is called reflux oesophagitis, and it may cause bleeding (perhaps anaemia) or a stricture. Cancer in a hiatus hernia is very rare, but there is a slight increased risk of it developing in the inflamed area.

What is the treatment?

Self-help

• Keep to your ideal weight.
• Avoid stooping.
• Avoid smoking.
• Reduce alcohol and coffee.
• Avoid tight corsets.
• Adjust your bed.
• Take antacid.
• Have small meals.
• Avoid spicy food.
• Avoid hot drinks.
• Avoid having supper.
• Avoid gassy drinks.

Losing weight nearly always cures it. Eating small meals each day instead of 2 or 3 large ones helps. You must have a light evening meal without alcohol and avoid supper so that your stomach is empty on retiring. It takes about 1 hour for the stomach to empty.

Smoking certainly aggravates it, as do coffee and alcohol, especially spirits. If symptoms occur at night, you are advised to use extra pillows to prop up you head and shoulders. If this fails, you should raise the head of your bed about 10 cm (4 inches) to prevent acid reflux at night.

Medical help

If over-the-counter antacids and other measures do not help, your doctor may prescribe a special mixture or tablets to reduce reflux. If your problem persists, an operation (which has good results) may be necessary.

The key to coping with a hiatus hernia is to keep at ideal weight.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia