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Heartburn/GERD Health Center

Frequently Asked Questions About Heartburn and Reflux

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3. I am a 55-year-old male who is about 30 pounds overweight. Lately, I've been experiencing frequent heartburn and have an acid taste in the back of my throat. Now, my doctor is telling me I have a hiatal hernia. Is this a serious problem? Will it require surgery? continued...

A hiatal hernia can develop in people of all ages and both sexes, although it frequently affects middle-aged people. In fact, the majority of otherwise healthy people over age 50 have small hiatal hernias.

Many people with a hiatal hernia never have any symptoms. In some people, acid and digestive juices escape from the stomach into the esophagus (gastroesophageal reflux). This causes:

  • Heartburn
  • A bitter or sour taste in the back of the throat
  • Bloating and belching
  • Discomfort or pain in the stomach or esophagus
  • Vomiting

Most hiatal hernias do not cause problems and rarely need treatment. Successful treatment of hiatal hernias usually involves treating the symptoms of gastroesophageal reflux disease (GERD) that are triggered by the additional pressure in the abdomen.

Treatment includes:

Making lifestyle changes, such as:

  • Losing weight, if you are overweight, and maintaining a healthy weight
  • Having a common-sense approach to eating, such as eating moderate to small portions of foods, and limiting fatty foods, acidic foods (such as tomatoes and citrus fruits or juices), foods containing caffeine, and alcoholic beverages
  • Eating meals at least three to four hours before lying down and avoiding bedtime snacks
  • Elevating the head of your bed by 6 inches (this helps allow gravity to keep the stomach contents in the stomach)
  • Not smoking
  • Wearing looser clothing, especially around the waistline
  • Taking medications, such as over-the-counter antacids or H2 blockers or PPIs. Note: If you take over-the-counter drugs and see no improvement or take them for longer than two weeks, see your doctor. He or she may prescribe a stronger medication.

If medications and lifestyle changes are not effective in treating your symptoms, diagnostic tests may be performed to determine if surgery is necessary.

People with a hiatal hernia who also have severe, chronic esophageal reflux may need surgery to correct the problem if their symptoms are not relieved through these management techniques. Surgery may also be needed to reduce the size of the hernia if it is in danger of becoming constricted or strangulated (so that the blood supply is cut off). During surgery, gastroesophageal reflux is corrected by pulling the hiatal hernia back into the abdomen and creating an improved valve mechanism at the bottom of the esophagus. The surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a tighter sphincter so that food will not reflux back into the esophagus.

Hiatal hernia surgery can be performed either by opening the abdominal cavity or laparoscopically. During laparoscopic surgery, five or six small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs on a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.

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