Hiatal Hernia Treatments and Medications

Over 200,000 people in the United States are diagnosed or treated for hiatal hernias every year. This type of hernia occurs in the upper portion of the stomach and interferes with the diaphragm. Many people may not even know they have a hiatal hernia—some don't need treatment with medication or surgery. Learn more about what a hiatal hernia is and what can be done to treat it in the following sections.

What is hiatal hernia?

A hiatal hernia develops when the stomach passes into the chest cavity (thorax) through the weakened muscles of the diaphragm, a dome-shaped muscular partition separating the stomach from the lungs. The diaphragm is an integral part of the respiratory system that contracts and relaxes when breathing. A small opening in the diaphragm, the hiatus, allows for the esophagus to pass through to part of your stomach and into the chest cavity. Approximately 8 inches long, the esophagus is a muscular tube responsible for delivering foods and liquids from the mouth to the digestive system. A hiatal hernia can be mild to severe and may require medical intervention that involves the stomach, diaphragm, and esophagus.

Types of hiatal hernias

Type 1 hiatal hernia is mostly mild and may not even be symptomatic. As the level of hernia progresses into type II, III, or IV, also called para esophageal hernia, the individual's condition worsens and typically requires medical intervention to resolve the problem. In addition, a strangulated hiatal hernia, in which the blood supply to the stomach is cut off, can also occur and is considered a medical emergency.

Causes of hiatal hernia

Anyone may experience a hiatal hernia. While it’s not always clear why some individuals develop a hernia, there are several causes:

• Age: Hiatal hernias often occur in individuals over 50 years old.

• Weight: Obesity is another factor that can lead to the development of a hiatal hernia.

• Injury: Hernias in the diaphragm can result from an injury to the area. For example, lifting heavy objects can trigger the development of a hernia.

• Straining: Recurring stress from straining while having or attempting to have a bowel movement can be a potential cause of a hiatal hernia.

• Coughing: Persistent coughing or vomiting, especially in older adults and smokers, can weaken the muscle tissue in the stomach and can also cause the onset of a hernia.

Additionally, if you are born with a larger-than-usual hiatus, you may naturally be prone to hernias. A variety of symptoms can indicate if a hiatal hernia has developed.

Symptoms of hiatal hernia

Symptoms associated with a hiatal hernia often vary from individual to individual. Mild reactions can include hiccups, belching, nausea, and slight heartburn. Some individuals experience pain in the chest after eating.

When the stomach pushes through the diaphragm, an individual may be able to feel the bulge or a hard lump in the abdomen. The pressure of a hernia can also cause stomach acids to flow back into the esophagus, also referred to as acid reflux. The lower esophageal sphincter (LES), the group of muscles that prevent stomach acid from rising up back into the esophagus, can be compromised if a hiatal hernia forms. Persistent acid reflux, also known as gastroesophageal reflux disease or GERD, can develop as a result of a hiatal hernia.

Additional symptoms of a hiatal hernia include throat irritation, mild to severe chest pains, difficulty swallowing, and shortness of breath. A more complicated hernia can cause gastrointestinal stress and irritation which can lead to internal bleeding, vomiting of blood, and anemia.

Consult a healthcare provider if you are experiencing any of these hiatal hernia symptoms. Getting a proper diagnosis to determine if you have a hiatal hernia is important before more damage occurs.

How is a hiatal hernia diagnosed?

First, your healthcare provider will give you a routine examination, then ask you a series of questions to collect information regarding your condition.

• What are your symptoms?

• Are your symptoms constant or periodic?

• Any excessive coughing or vomiting?

• Are you experiencing acid reflux?

• Was there an injury that may have prompted your hernia to develop?

• How long have your symptoms been present?

• Does anything seem to make your condition better or worse, such as exercise or eating?

Be sure to write down your symptoms so you don’t forget anything. Some patients find keeping a log or journal of the severity of the symptoms is helpful. A food and activity log can provide insightful information about your ailment.

Once symptoms have been reviewed, there are several ways to determine if a patient is experiencing a hiatal hernia. A pH test can measure the presence of acid in the esophagus. If there is enough evidence of a hernia, further examination may be necessary. Your regular physician or healthcare provider may refer you to a gastroenterologist, a doctor who specializes in digestive disorders.

One of the first methods to gain a deeper perspective on your internal workings is through barium swallow which utilizes a special type of X-rays. X-rays of the upper part of the stomach can provide a visual image of any herniated muscles near the diaphragm. Before the procedure, the patient must drink a barium solution that coats the stomach’s lining. The barium swallow will allow a specialist to analyze the silhouette of the digestive system to diagnose a hernia and determine the severity of the condition.

An endoscopy is another option to diagnose a hiatal hernia. During the procedure, a small flexible tube with a camera and light (the endoscope) is inserted through the patient's mouth, down the esophagus, and into the stomach to view the problem area. The doctor will then be able to see if there is any inflammation or herniation of muscle near the diaphragm. In preparation for an upper endoscopy, the patient is often given a sedative to relax or be sedated. The process takes approximately 20 to 30 minutes to complete, then the endoscope is removed.

Hiatal hernia treatment options

Treatment options will vary depending on the severity of the hernia. For example, a very mild or type I hiatal hernia may not need formal intervention. A more serious type of hiatal hernia may require a variety of treatments including medication and surgery.

Hiatal hernia surgery

While medication and lifestyle changes can greatly aid in reducing symptoms and promote healing, surgery is sometimes necessary to correct a hiatal hernia. A hiatal hernia can become recurrent or a medical emergency and the patient needs an operation referred to as Nissen fundoplication. 

During the surgical process, the herniated stomach is pulled down from the opening in the diaphragm and reset in the proper position. The top of the stomach is wrapped around the lower esophagus to restore normal function. In addition, the hiatus is made smaller to prevent future bulging. The esophageal sphincter may need to be reconstructed to aid in reducing acid reflux symptoms associated with hiatal hernia and any hernia sacs that may have developed will be removed during the process.

Small incisions on the abdominal cavity will allow the surgeon to perform the operation laparoscopically. The doctor will be able to view the location of the hernia with a small camera (laparoscope) inserted through the opening made on the abdomen. The image will be displayed on a screen to complete the surgery.  

Recovery from hiatal hernia surgery may take two to four weeks. Patients should refrain from lifting heavy objects and strenuous activity for several months following the operation. Hernias can reappear, thus being mindful and participating in recommended lifestyle changes can help ensure the success of the surgery. Consult a doctor if you are experiencing signs of a hiatal hernia. 

Over-the-counter medications

In an effort to treat symptoms associated with a hiatal hernia, many individuals utilize over-the-counter medications (OTC). Some non-prescription medications used to treat hiatal hernia reduce the body’s production of acid. While acids are necessary to break down food in the stomach, excessive acid can be irritating to inflamed and weakened muscle tissue and stomach lining. 

By using over-the-counter drugs that decrease stomach acid, the damaged muscles and tissue are given an opportunity to heal. Commonly used antacid medications include Maalox and Tums.

Histamine agonists are another type of medicine available without a prescription that aids in reducing acids that worsen hiatal hernia symptoms. Two of the most commonly used OTC h-2 blocker medicines in this category include Zantac and Pepcid. Recently, the FDA has recalled Zantac from the market due to an increased risk of cancer. 

Prescription drugs

Although OTC medicine can be very helpful, it is often only a short term solution for many people. Prescription medication may be necessary to treat recurrent hiatal hernia symptoms.

Some OTC drugs are also available in prescription form. Prescription medications used to treat hiatal hernias are most often proton pump inhibitors (PPI). PPIs are used to reduce stomach acid production. Prescription-strength PPIs are the most effective in reducing acid secretion. Prilosec, Nexium, and Prevacid are among the most commonly prescribed prescription drugs for a hiatal hernia.

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