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.
- 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
- Age 50, or older
- 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.
Treatments and drugs
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.
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.
- 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.