CNN

Small hiatal hernias
Most small hiatal hernias cause no signs or symptoms.

Large hiatal hernias
Larger hiatal hernias can cause signs and symptoms such as:

• Heartburn
• Belching
• Chest pain
• Nausea

When to see a doctor
Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It's not always clear why this happens, but pressure on your stomach may contribute to the formation of hiatal hernia.

How a hiatal hernia forms
Your diaphragm is a large dome-shaped muscle that separates your chest cavity from your abdomen. Normally, your esophagus passes into your stomach through an opening in the diaphragm called the hiatus. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of your stomach bulges up through the diaphragm into your chest cavity.

Possible causes of hiatal hernia
Hiatal hernia could be caused by:

• Injury to the area
• An inherited weakness in the surrounding muscles
• Being born with an unusually large hiatus
• Persistent and intense pressure on the surrounding muscles, such as when coughing, vomiting, or straining during a bowel movement or while lifting heavy objects

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Hiatal hernia is most common in people who are:

• Age 50 or older
• Obese
• Smokers

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Whom to see
Make an appointment with your family doctor or a general practitioner if you have signs or symptoms that worry you.

If you've been diagnosed with a hiatal hernia and are experiencing signs and symptoms that aren't controlled with medications and lifestyle changes, ask your doctor for a referral to a doctor who specializes in digestive diseases (gastroenterologist).

How to prepare
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. To get ready for your appointment, try to:

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions to ask
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For hiatal hernia, some basic questions to ask your doctor include:

• What caused my hiatal hernia?
• Will I need treatment for my hiatal hernia?
• Do I need more tests?
• What are my treatment options?
• What are the benefits and risks of each option?
• I have these other health conditions. How can I best manage them along with my hiatal hernia?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing for me?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain, such as:

• An X-ray of your upper digestive tract. During a barium X-ray, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
• Using a scope to see inside your digestive tract. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Most people with hiatal hernia don't experience any signs or symptoms, and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.

Medications for heartburn
If you experience heartburn and acid reflux, your doctor may recommend medications, such as:

• Antacids that neutralize stomach acid. Over-the-counter antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, may provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
• Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) or ranitidine (Zantac 75). H-2-receptor blockers don't act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
• Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Stronger versions of these medications are available in prescription form.

Surgery to repair a hiatal hernia
In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for emergency situations and for people who aren't helped by medications to relieve heartburn and acid reflux. Hiatal hernia repair surgery is often combined with surgery for gastroesophageal reflux disease.

An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removal of the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Lifestyle changes may help control the signs and symptoms of acid reflux caused by a hiatal hernia. Consider trying to:

• 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.
• Limit the amount of fatty foods you eat.
• Sit up after you eat, rather than taking a nap or lying down.
• Eat at least 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).
• Work to reduce the stress in your daily life.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.

Some alternative medicine practitioners claim to have discovered a way to cure a hiatal hernia by pushing the stomach back to its normal position below the diaphragm. Practitioners may use their hands to apply pressure to the abdomen and manipulate the stomach.

There's no evidence that such manipulation works to cure hiatal hernia. No clinical trials of the technique have been conducted.

©1998-2009 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.