Hiatus hernia: diagnosis and treatment

How is a hiatus hernia diagnosed?

normal oesophagus and stomach 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.

Hiatus hernia is generally diagnosed when doctors perform a barium X-ray or endoscopy. Large hiatus hernias can be observed on plain chest X-rays.

Barium X-ray

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. With either test, the hiatus hernia will show up as a bulge that is positioned between the oesophagus and your stomach.

How is a hiatus hernia treated?

hiatus hernia

Sliding hiatus hernia

A hiatus hernia, particularly a small one of the sliding type, is generally a common condition that does not cause many symptoms or problems and your doctor will be able to advise you on the best way to avoid complications. This type of hiatus hernia does not usually cause obstruction or strangulation so surgery is very rarely required.

If your hernia is causing symptoms of gastro-oesophageal reflux, your doctor may direct treatment at solving the symptoms of your reflux. They may recommend you try self-care measures that can help reduce discomfort or pain. These will probably include changes to your lifestyle or diet including weight reduction if you are overweight. If these don’t help, however, your doctor may advise medication as the next step.

Medications used to treat gastro-oesophageal reflux symptoms

Medications used to treat gastro-oesophageal reflux symptoms include the following.

  • Over-the-counter antacids. These 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, Gelusil, 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.
  • Histamine blocker medications (known as H2-blockers or H2-receptor antagonists) reduce the amount of acid your stomach secretes. They include cimetidine (brand name Tagamet); famotidine (Pepcidine); nizatidine (Tazac); and ranitidine (Zantac). Small packs of ranitidine (Zantac 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 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 lansoprazole (Zoton), omeprazole (Losec, Acimax), esomeprazole (Nexium), rabeprazol (Pariet) and pantoprazole (Somac).

Rolling hiatus hernia

A rolling hiatus hernia is not as common as a sliding hiatus hernia, and is much more likely to cause obstructions and strangulations and so are more likely to need corrective surgery. Surgery is not common and is usually only necessary to repair large 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.

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 muscles in the lower part of the oesophagus;
  • attaching the part of the stomach that has bulged through the diaphragm to the back of the abdominal wall; or
  • attaching the top few centimetres of the stomach around the oesophagus to prevent heartburn.

The surgery may be either open or laparoscopic (‘keyhole’) surgery. In most cases, surgery for hiatus hernia has good results.

If you are experiencing symptoms from your hiatus hernia, your doctor can generally treat the problem easily and advise you on ways to minimise any discomfort.

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