Hiatus hernia: diagnosis and treatment
How is a hiatus hernia diagnosed?
The most common symptoms caused by hiatus hernia are usually those due to gastro-oesophageal reflux and so hiatus hernia is often hard to tell apart from reflux just based on symptoms. It’s important to not assume that you have a hiatus hernia based on symptoms alone. Always see your doctor for a proper diagnosis.
Hiatus hernia is most commonly diagnosed when doctors do an endoscopy to investigate reflux, or when a barium X-ray has been performed. The hiatus hernia can show up as a bulge that is positioned between the oesophagus and your stomach. Large hiatus hernias can be observed on plain chest X-rays.
A barium swallow test or barium meal is a test in which you will be asked to drink a chalky liquid containing barium that helps your internal organs show up more clearly on X-ray pictures. The barium will outline your gullet, stomach and upper part of your small intestine. This test may help your doctor see whether you have a hiatus hernia.
Endoscopy or gastroscopy
Another way your doctor may check for a hiatus hernia is by referring you for a gastroscopy, which is an endoscopic examination. This is where you are given a light sedative and a doctor will insert a thin flexible lighted tube (an endoscope) down into your oesophagus (gullet).
The tube allows the doctor to ‘look’ at your oesophagus and check for abnormalities. This common procedure is usually painless and is generally performed in day surgery centres in public or private hospitals.
How is a hiatus hernia treated?
A hiatus hernia, particularly a small one of the sliding type, is a common condition that does not usually cause many symptoms or problems.
If your hiatus hernia is causing symptoms of gastro-oesophageal reflux, your doctor may direct treatment at solving the symptoms of your reflux.
Self-care measures that can help reduce heartburn discomfort or pain include changes to your lifestyle or diet including weight reduction if you are overweight. If self-care measures for reflux don’t help, your doctor may advise medication as the next step.
Medicines used to treat gastro-oesophageal reflux symptoms
Antacids are available from pharmacies and include:
- calcium carbonate (e.g. Andrews TUMS Antacid);
- aluminium hydroxide (e.g. Alu-Tab); and
- mixtures containing several preparations (e.g. Gaviscon, Mylanta).
Antacids ease pain by working against the excess acid in your oesophagus to neutralise it. They won’t stop the acid from being produced, so be aware that if you stop taking them, it’s very likely your symptoms will return.
Side effects can include diarrhoea and constipation.
Histamine blocker medications
Histamine blockers, known as H2-blockers or H2-receptor antagonists, reduce the amount of acid your stomach secretes. They include:
- cimetidine (brand name Tagamet, Magicul);
- famotidine (Pamacid, Pepzan);
- nizatidine (Tazac, Tacidine); and
- ranitidine (Zantac, Rani 2, Ranoxyl).
Possible side effects of H2-receptor antagonists include diarrhoea, tiredness and headaches.
Small packs of ranitidine (Zantac Relief, Ranoxyl Heartburn Relief) are available from the pharmacist, but if your symptoms are severe, your doctor will probably advise stronger doses of H2 blockers, which are only available on prescription.
Proton pump inhibitors
Proton pump inhibitors block the production of acid and so allow the tissue that has been damaged by the acid to heal. They are usually very effective medicines and doctors consider them safe for long-term use.
Proton pump inhibitors include:
- esomeprazole (Nexium);
- lansoprazole (Zoton, Zopral);
- omeprazole (Losec, Acimax Maxor, Omepral);
- pantoprazole (Somac, Salpraz); and
- rabeprazole (Pariet, Prabez).
Side effects can include headaches, diarrhoea and nausea.
Proton pump inhibitors that are available over-the-counter from the pharmacist, usually in a lower strength, include:
- omeprazole (Maxor Heatburn Relief);
- rabeprazole (Pariet 10); and
- pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief).
Symptoms of gastro-oesophageal reflux should generally be treated with standard-dose proton pump inhibitors. Symptoms not responding to standard doses or recurring soon after stopping treatment should be investigated – see your doctor.
Surgery is not common and is usually only necessary to repair large hiatus hernias or hernias in people who haven’t been helped by medication or who are getting complications from their hernia, such as obstruction of the oesophagus, severe pain, or bleeding.
Surgery is very rarely required for sliding hiatus hernias. Rolling hiatus hernias are much more likely to cause obstructions and strangulations than sliding hiatus hernias, and so are more likely to need corrective surgery.
Depending on the nature of your hernia, the surgery may involve:
- pulling the stomach back down into the abdomen under the diaphragm;
- tightening the opening in the diaphragm where the oesophagus passes through;
- strengthening the area where the oesophagus joins the stomach; and
- anchoring the stomach below the diaphragm.
The surgery may be either open or laparoscopic ('keyhole') surgery. There are possible side effects associated with surgery – your doctor will be able to discuss the risks and benefits of surgery for hiatus hernia.
- 1. Diagnosis of gastro-oesophageal reflux (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Jul. http://online.tg.org.au/complete/ (accessed Oct 2015).
2. MayoClinic. Hiatal hernia (updated 3 Feb 2015). http://www.mayoclinic.org/diseases-conditions/hiatal-hernia/basics/causes/con-20030640 (accessed Oct 2015).
3. NHS Choices. Hiatus hernia (updated 12 Mar 2015). http://www.nhs.uk/Conditions/Hernia-hiatus/Pages/Introduction.aspx (accessed Oct 2015).
4. National Digestive Diseases Information Clearinghouse (NDDIC). Gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD) in adults (updated Sep 2013). http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-adults/Pages/overview.aspx (accessed Oct 2015).