What is a hiatal hernia?

A hiatal hernia is a condition in which part of the stomach protrudes through the diaphragm from the abdomen into the chest. The diaphragm is a thin sheet of muscle that is involved in breathing. It separates the abdomen from the chest.

Hiatal hernias are common after middle age. They do not often cause problems.

How does it occur?

The cause of hiatal hernias is not known. What is known is that they occur more often in people after middle age, in overweight people (especially women), and in smokers.

What are the symptoms?

Many people with a hiatal hernia never have any symptoms. However, in some people, stomach acid and digestive juices move up into the esophagus via the bulge of the stomach through the diaphragm. This is called gastroesophageal reflux and can cause:

• heartburn, especially after you eat large meals or lie down

• a bitter or sour taste in the back of your throat

• bloating and belching

• discomfort or pain in your stomach or esophagus

• vomiting.

How is it diagnosed?

Because many hiatal hernias do not cause symptoms, they are often discovered during an investigation for other conditions.

If you have symptoms, your doctor will make the diagnosis from your medical history and a physical examination.

Your doctor may order other tests to confirm the diagnosis and rule out other causes of your symptoms. These tests might include:

• esophagoscopy (examination with a viewing tube to check for signs of acid in your esophagus)

• biopsy (to check for cancer)

• barium x-ray (to show whether or not stomach contents are escaping into the esophagus).

How is it treated?

Your doctor may recommend a change in your diet. If you are overweight, you may also be given suggestions for losing weight.

Your doctor may prescribe medication to buffer the acidity in your esophagus.

About 1 in 20 people with hiatal hernia need surgery.

How can I take care of myself?

• Follow the treatment recommended by your doctor.

• If you smoke, quit.

• If you eat one or two large meals a day, try to eat three or four smaller meals instead. Don't eat during the 2 to 3 hours before you go to bed.

• Avoid drinks containing caffeine (tea, coffee, cocoa, colas, etc.) or alcohol before you go to bed.

• Sit up during meals and for 1 hour after the meals.

• Elevate the head of your bed 6 inches by placing blocks under the bed frame.

• Wear clothes and belts that are loose around your waist.

• If you are overweight, try to lose some weight. Ask your doctor for help.