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
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:
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
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
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.
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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