Understanding Hiatal Hernia -- Diagnosis and Treatment
How Is a Hiatal Hernia Diagnosed?
A physical exam for hiatal hernia is similar to that for heartburn, with two additions: X-rays may be ordered to show the hernia, and if anemia is a concern, a blood sample may be taken to check your red blood cell count.
A hiatal hernia can be diagnosed with a specialized X-ray study that allows visualization of the esophagus and stomach (barium swallow) or with endoscopy (a test that allows the doctor to view the hernia directly.) An esophageal manometry test (pressure study) may also be performed in which the strength and muscle coordination of the esophagus is measured while swallowing. A pH test can also measure the acid levels in the esophagus.
For most people, heartburn is a treatable symptom. Frequent heartburn may indicate acid reflux or gastroesophageal reflux disease, also known as GERD. When treatment doesn't work and heartburn is severe despite lifestyle changes, surgery may be an option. It may also be an option if GERD causes other medical problems. Minimally invasive procedures using endoscopy are also available to treat acid reflux.
Most people do not experience any symptoms of their hiatal hernia, so no treatment is necessary.
But if you do have heartburn, there are many things you can do at home to relieve your symptoms: Refrain from eating large meals; instead, eat four or five small meals each day, and eat slowly. This, along with maintaining a weight in proportion to your height, will minimize abdominal pressure and heartburn. Reducing fat in your diet and avoiding foods that aggravate your symptoms may also substantially reduce symptoms. Also, avoid caffeine and alcohol, which tend to worsen symptoms. Smoking is an intense heartburn generator; if you smoke, stop.
In most cases, if lifestyle changes don't work, your doctor can either prescribe or point you to over-the-counter remedies for heartburn symptoms.
Paraesophageal hernias, however, should be repaired by surgery because the danger of strangulation is high. Surgery may also be needed when sliding hernias bleed or become large, strangulated, or inflamed. In surgery, the hiatus is reinforced and the stomach is repositioned. This surgery is now commonly done using a laparoscope, a thin, telescope-like instrument for viewing inside the abdomen. Typically, a one- to two-night hospital stay is required and regular activity may be resumed in two weeks.