A hiatal hernia is a protrusion of stomach tissue into your chest cavity, which causes overlapping with your oesophagus. This type of hernia is caused by straining your stomach muscles, which can occur as a result of prolonged coughing or being overweight. If your GP suspects you have a hiatal hernia, which is characterised by chest pain, heartburn and difficulty swallowing, they will refer you for an upper gastrointestinal series to confirm the diagnosis. Your treatment plan will depend on the severity of your symptoms and the findings of the diagnostic test, and treatment options include the following three approaches:
Your GP (like those at Travellers Medical Services) or dietitian will discuss your current diet and provide you with information on the types of food, such as coffee and fried foods, that can aggravate your symptoms. You should also keep a food diary to establish your own trigger foods, and your doctor or dietitian can help you detect any patterns in your food diary. If your hernia is thought to be caused by your weight, a dietitian will help you reach a healthy weight without compromising your nutrition. Changes to your sleep environment can also ease your symptoms. For example, using a wedge pillow to keep your head and upper body propped up while you sleep can prevent stomach acid flowing backwards up your oesophagus when you lie down.
It's often a case of trying a few different prescription drugs to find the one that helps manage your symptoms most effectively, but your doctor will discuss the appropriate medications for you to try. For example, if your symptoms aren't too bothersome, your doctor may suggest you start with antacids to neutralise your stomach acid, but if your symptoms are causing you a lot of pain and getting in the way of your daily life, you may be advised to take proton pump inhibitors, which reduce the amount of acid your stomach makes. If your upper gastrointestinal series showed your oesophagus was inflamed or irritated, alginates can be used to coat and protect the delicate oesophageal tissue.
Keyhole surgery to narrow the space in your diaphragm that enables your stomach and oesophagus to join together is commonly performed when more conservative approaches have failed to control your symptoms. Narrowing this gap stops your stomach acid reaching your oesophagus and your stomach tissue spilling into your chest cavity. The procedure is often carried out as a day case, and the keyhole approach will leave you with just a few tiny incision scars as opposed to the large abdominal scar that's left when you undergo open surgery.
If you find yourself avoiding social settings or struggling to keep up with work due to your symptoms, talk to your doctor. Hiatal hernias can usually be managed when you identify a suitable treatment.