When part of the stomach protrudes up into the hiatus--the opening in the diaphragm--it is known as a hiatal hernia. While small protrusions may cause minimal symptoms, large hiatal hernias can result in severe heartburn, acid reflux and abdominal bloating. The approach to treatment typically depends upon the severity and nature of symptoms, as well whether the patient smokes, is obese or has any other associated risk factors.
Lifestyle Changes
People experiencing only mild symptoms of heartburn or bloating caused by a hiatal hernia may successfully treat their condition by making various lifestyle changes. Modifying the type and amount of food consumed, as well as the timing of meals may help to alleviate symptoms. Specifically, the Cleveland Clinic recommends limiting intake of highly acidic foods such as citrus fruits and juices and caffeinated and alcoholic beverages, as all these can aggravate the stomach lining and increase the production of acid. Avoiding eating late at night and eating small-to-moderate portions may also prove beneficial. The National Institutes of Health also recommends avoiding bending or lying down immediately following meals. People who are overweight or obese are likely to improve the symptoms of their condition by losing weight, and those who smoke can reduce their symptoms by stopping smoking.
Medication
Over-the-counter and prescription medications are available to address symptoms of acid reflux and heartburn. According to MayoClinic.com, individuals with mild to moderate symptoms may neutralize stomach acid using antacids containing magnesium or aluminum like Maalox, Mylanta, Rolaids or Tums. While these are readily available over-the-counter, they can cause side effects that include diarrhea and constipation. Additionally, they may not be effective in severe cases as they do not cure underlying physical damage to the esophagus caused by acid.
Medications to stop the production of acid and facilitate healing of the esophagus include over-the-counter proton pump inhibitors containing lansoprazole--such as 24-hour Prevacid--and omeprazole--such as Prilosec OTC. Other over-the-counter medications called histamine-2 receptor blockers also help to reduce acid production and heartburn symptoms. These include cimetidine, or Tagamet HB, ranitidine, or Zantac 75, and famotidine, or Pepcid AC. Stronger versions of both proton pump inhibitors and histamine-2 receptor blockers are available from your doctor by prescription.
Surgery
According to the Cleveland Clinic, surgical treatment of an hiatal hernia is warranted in two conditions--when the patient suffers from gastroesophageal reflux disease that has not responded to other types of treatment, and when the hernia has become strangulated, obstructing the passage of food and waste through the intestine. MayoClinic.com advises that hiatal hernia surgery is usually conducted in one of three ways. Doctors may perform a thoracotomy, operating on the hernia through an incision in the chest; they may perform a laparotomy, operating on the hernia through an incision in the abdomen; or, they may perform laparoscopic surgery--a less invasive operation in which doctors make several tiny incisions in the abdomen and use a small camera and special surgical instruments to fix the hernia.
