Hiatal Hernia: Symptoms, Surgery & Other Treatment Options

A hiatal hernia is characterized by a portion of the stomach that bulges through a region called the esophageal hiatus. The esophageal hiatus is a small hole in the diaphragm that serves to anchor the esophagus.

The causes of hiatal hernias are not very well understood, but obesity and excessive physical activity are risk factors associated with this type of hernia. Because the stomach is displaced and below the diaphragm, acid content will tend to back-up into the esophagus, causing reflux and a burning sensation in the throat.

A hiatal hernia diagnosis can be suspected by the doctor after assessing reflux symptoms, although the only way to confirm it is to visualize the hernia through procedures like an endoscopy or a barium swallow test.

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Common symptoms

Most people who have hiatal hernias do not have symptoms. Those who do have symptoms, however, usually experience them about 20 to 30 minutes after meals and they tend to disappear shortly after. The main symptoms are:

  • Heartburn and burning in the throat;
  • Difficulty swallowing;
  • Dry, persistent cough;
  • Frequent bitter taste in the mouth;
  • Bad breath;
  • Frequent belching;
  • Sensation of slow digestion;
  • Urge to vomit frequently.

These symptoms are also associated with reflux and, therefore, it is common for gastroesophageal reflux (GERD) to be diagnosed before a hiatal hernia. 

When surgery is indicated

Surgery for a hiatal hernia is indicated only in severe cases, when dietary changes are not enough to alleviate the symptoms. Surgery will also be performed when the hernia becomes strangulated (ie. when blood supply to the hernia is cut-off).

Hiatal hernia surgery is performed laparascopically (through small holes punctured in the abdomen) and under general anesthesia. Full recovery takes about 2 months. 

Other treatment options

The best treatment option for hiatal hernia is weight loss, and it is necessary, in most cases, to make diet adjustments and avoid eating high-fat or very spicy foods and drinking alcoholic beverages. These foods are more difficult to digest and can worsen the symptoms of the disease and should always be avoided.

In addition, it is important to have small light meals every 3 hours to treat the discomfort caused, as well as avoid going to bed soon after eating and not drink liquids with meals.

When surgery is indicated

Surgery for hiatal hernia is indicated only in severe cases and when dietary changes are not enough to alleviate the symptoms caused by gastroesophageal reflux or when there is strangulation of the hernia.

This type of surgery is performed through laparoscopy, under general anesthesia and full recovery takes about 2 months. 

Possible causes

Hiatal hernia can be caused by excessive physical activity that requires a lot of strength, such as weight lifting. In addition, excess weight, GERD, and chronic cough can also cause hiatal hernia, especially in elderly people. However, in most cases, it is not possible to identify the origin this condition.