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Hiatal hernia

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When one part of the body protrudes through an opening into another part of the body, a hernia occurs. Hiatal hernias - also known as diaphragmatic hernias - form at the opening (hiatus) in diaphragm where the food pipe (esophagus) joins the stomach. When the muscle tissue around the hiatus becomes weak, the upper part of your stomach may bulge through the diaphragm into your chest cavity.


If you don't have any signs or symptoms from a hiatal hernia — and most people don't — you probably won't need any treatment. But if you're experiencing recurrent gastroesophageal reflux, you may get relief from a few simple changes in your lifestyle. If you're overweight, losing weight alone may relieve your symptoms.

If lifestyle changes and weight loss aren't effective, some medications may help ease symptoms. They include:

  • Antacids. Over-the-counter antacids (Maalox, Mylanta, Tums) can neutralize the acidity in your esophagus and provide relief from heartburn. Keep in mind that these medications don't cure heartburn — they merely relieve symptoms. Once you stop taking antacids, your symptoms usually return.

  • H-2 blockers. These medications reduce the amount of acid secreted by your stomach by blocking histamine receptors. They include famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) and nizatidine (Axid), which are available over the counter. If you have more severe heartburn or esophagitis, your doctor may prescribe stronger doses of H-2 blockers. It's best to take these medications before a meal that may give you heartburn. You can also take them after symptoms occur, but it takes about 30 minutes for them to work. Your doctor may recommend that you take an acid blocker for a few months, or longer. Occasionally you may experience some side effects such as bowel changes, dry mouth, dizziness or drowsiness. In addition, H-2 blockers shouldn't be taken with certain other medications because of the risk of a serious interaction. If you use an acid blocker and also take other medications, check with your doctor or pharmacist about possible drug interactions.

  • Proton pump inhibitors (PPIs). These drugs — which include lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), omeprazole (Prilosec) and esomeprazole (Nexium) — are the most effective drugs for the treatment of GERD. They block acid production and allow time for damaged esophageal tissue to heal. They're also convenient because you have to take them only once a day. But they're more expensive than other GERD medications. Proton pump inhibitors are generally safe and tend to be well tolerated, even for long-term treatment. To prevent possible side effects — such as stomach or abdominal pain, diarrhea or headache — your doctor will likely prescribe the lowest effective dosage. Check with your doctor or pharmacist about possible drug interactions if you're taking other medications.

Surgical repair
A few people with a symptomatic hiatal hernia may need surgery. This is usually considered only when medications and lifestyle changes fail to relieve severe reflux symptoms, or when you have complications such as chronic bleeding or narrowing or obstruction of your esophagus. Large hiatal hernias may also need repair if they cause symptoms such as shortness of breath, difficulty breathing or swallowing, or chest pain.

An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, or reconstructing a weak esophageal sphincter. In some cases this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert instruments and a fiber-optic camera through several small incisions in your abdomen. The operation is then performed while your surgeon views the images on a video monitor (laparoscopic surgery).

Laparoscopic surgery generally causes less pain and scarring and requires a shorter hospital stay than thoracotomy or laparotomy, but it's not appropriate for everyone. In addition, hernias may recur more frequently with this procedure than with open surgery.

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