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.
No matter what you eat, you worry that chronic heartburn will always be there. You've tried all the antacids, followed a bland diet, given up on certain foods completely. But still you wake up in the middle of the night, sometimes with pain deep in your throat, other times with a sore throat and trouble breathing, as if you were having an asthma attack. You try to sleep sitting up in a chair, and realize with dismay: This has been going on for years.
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 healthy weight, 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 health care provider 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. This approach is less invasive and allows for faster recovery. Typically, a one- to two-night hospital stay is required, and regular activity can often be resumed in two weeks.