Hiatal Hernia

by Dr. Karen Leggett

General Information

A hiatal hernia occurs when the stomach protrudes through the opening in the diaphragm. It is a very common finding and occurs in approximately half the adult population of the United States. There are two types of hiatal hernia. The most common form is a sliding hiatal hernia. Far less common is a variety called a paraesophageal hiatal hernia. The paraesophageal variety may be associated with complications such as bleeding. This type of hiatal hernia is not particularly a problem of elderly patients.

Sliding hiatal hernia does seem to occur with increasing frequency in elderly patients. The hernia itself only rarely causes a health problem, and then only if it is very large. Sliding hiatal hernia occurs with several other medical problems. Reflux of acid into the esophagus is common with a sliding hiatal hernia. Reflux produces heartburn and can cause scarring in the esophagus. These associated problems may require special diagnosis and treatment, and these problems, not the hiatal hernia, are the focus of your physician’s attention.

Important Points in Treatment
The treatment of the symptoms caused by hiatal hernia involves the prevention of reflux of acid from the stomach into the esophagus. The following changes will reduce the occurrence of reflux:

  1. Elevate the head of your bed. Use blocks or bricks under the head end of the bed. Simply propping your head up on pillows is not effective. A foam wedge made to be placed under the mattress can be used if you cannot elevate the head of your bed.
  2. Do not eat or drink for 2 hours before going to bed. If the stomach is nearly empty when you go to bed, there is little acid to reflux into the esophagus.
  3. Do not wear tight, elastic, or restricting garments. Any binding that raises the pressure inside the abdominal cavity promotes reflux.
  4. Stoop rather than bend over to pick up objects from the floor. This decreases the chance for reflux to occur.

Besides following these measures, you may be given medication by your physician, who may select from several medications that can decrease the acid production in the stomach, neutralize the acid, or strengthen the muscle in the lower esophagus to prevent reflux.

Notify Our Office If ...

  • You experience frequent, persistent heartburn.
  • You experience regurgitation of food into your mouth.
  • You awaken with a bitter taste in your mouth and/or hoarseness.
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