A hiatal hernia forms when a portion of your stomach pushes through into the opening of the diaphragm (where the food pipe connects with the stomach). These types of hernias can cause heartburn, acid reflux and chest pain. Treatments for hiatal hernias include self-care strategies, medications to manage symptoms and, in some cases, surgery.
Antacids counteract acid in the esophagus and alleviate heartburn. Common over-the-counter antacids include Maalox, Mylanta and Tums. They do not get at the root of heartburn but simply suppress symptoms so it will return once you stop taking them.
H-2 blockers interfere with acid secretion in the stomach. Common over-the-counter brands include Pepcid, Tagamet, Axid and Zantac. If you have a more severe case, your doctor might give you prescription-strength versions of these medications. Take them before eating a meal that might cause heartburn; you can also use them after but it will take about 30 minutes to kick in. Side effects include bowel changes, dry mouth, dizziness and drowsiness. Be sure to tell your doctor about any other medications you are taking before starting this treatment.
Proton-Pump Inhibitors (PPIs)
PPIs (Prevacid, Aciphex, Prilosec, Nexium) stop acid production and help damaged stomach tissue heal. You only need to take them once a day, but they are more expensive than other medications used to address these symptoms. To circumvent possible side effects like stomach and abdominal pain, your doctor will give you the lowest dose that is effective. Again, be sure to let your doctor know about any additional medications you are on to avoid interactions.
You might need surgery if your hernia is large, has not responded to other treatment or if you experience problems like bleeding or obstruction of the esophagus. Surgery involves pulling your stomach into your abdomen and reducing the size of the diaphragm. The surgeon might go in through the chest wall (thoracotomy) or abdomen (laparotomy). Your type of surgery will depend on the nature of your hernia and how experienced the surgeon is in the different surgeries.
Eat smaller meals to avoid distending your stomach, which pushes it into your chest. Avoid foods that encourage the production of stomach acids and irritate the lining; they include alcohol, caffeinated drinks, chocolate, onions, spicy foods, citrus fruits and tomato-based foods. Decrease your consumption of fatty foods. They decrease the rate at which foods leave the stomach, allowing more time for acid to back up into your esophagus. Do not lie down or go to sleep for at least three hours after eating. Wait two to three hours after a meal to exercise.
Being overweight puts pressure on your stomach and worsens symptoms. Quit smoking to decrease acid reflux production and prevent your saliva from drying up; saliva helps protect your esophagus from acid. Do not take calcium channel blockers, tetracycline, aspirin, ibuprofen, naproxen sodium, quinidine, theophylline, sedatives, tranquilizers or alendronate. Do not wear tight-fitting clothes. Manage stress as best you can since it slows digestion, which gives acid more time to form.