Answers
What is a hiatus hernia, and does it need surgery?
Short answer
A hiatus hernia means the top of the stomach has slid up through the opening in the diaphragm into the chest. It is common, especially with age, weight gain and pregnancy, and often found during an endoscopy. Small hernias often cause no symptoms or only reflux, treated with lifestyle changes and medicines. Surgery is needed only in a few people.
Symptoms
- Heartburn and acid coming up, worse after large meals or lying down
- Burping, fullness or chest discomfort after eating
- Many people have no symptoms at all
How it is found
An upper GI endoscopy usually shows it, along with any damage to the food pipe. A barium swallow X-ray or a CT scan shows larger hernias. Tests of food pipe pressure and acid are done before surgery.
Treatment
Surgery (keyhole repair with a wrap around the food pipe) is considered for reflux that does not respond to medicines, for large hernias causing symptoms, or for complications.
- Weight loss if overweight, smaller meals, dinner at least 3 hours before bed
- Raising the head end of the bed, and avoiding tight belts after meals
- Acidity medicines when needed
When it is urgent
Sudden severe chest or upper belly pain with retching, inability to swallow or vomiting can mean a large hernia has twisted. This is an emergency. Chest pain with sweating or breathlessness should always be treated as a possible heart attack first.
Diet with a hiatus hernia
Eat more
- Small meals, eaten slowly
- An early, light dinner
- A short walk after meals instead of lying down
Cut down
- Large meals and late-night eating
- Fried food, chocolate, mint, fizzy drinks and too much tea or coffee
- Tight clothes or belts and bending after meals
Good to know
- Losing even a few kilos can reduce reflux noticeably.
- No food shrinks a hernia; diet controls the symptoms.
Common questions
Will the hernia get bigger?
Small hernias often stay the same for years. Weight gain, straining and chronic cough can make them larger.
Can exercise or yoga fix a hiatus hernia?
Exercise and weight loss help symptoms. Postures with the head down or heavy straining soon after meals can worsen reflux.
Is surgery safe?
Keyhole surgery is safe in experienced hands. It is advised only when symptoms persist despite medicines or the hernia is large.