A hiatus hernia occurs when there is widening of the natural opening in your diaphragm muscle that separates the chest cavity from the abdominal cavity. This natural opening (hiatus), allows the oesophagus (gullet) to pass through from the chest to the abdomen where it then joins the stomach.
Widening of the hiatus means that the stomach (and occasionally other organs) can slide up into the chest cavity. In some people this can lead to increased acid reflux and rarely to trapping of part of the stomach in the chest making it difficult for food to pass easily into the stomach.
What symptoms can I get?
Some people get no symptoms at all.
Some people get an increase in reflux or regurgitation of stomach acid and other juices, or even food, into the oesophagus. Sometimes this reflux can even reach the mouth. Acid reflux may be felt as a burning sensation behind the breastbone (sternum). It may produce a bad taste in the mouth and can even lead to tooth decay. In some people it can cause irritation of the larynx (voice box) and cause breathing problems similar to asthma.
In people who get a lot of reflux, bending over to tie up a shoelace may lead to regurgitation of fluid into the mouth - and some people find that they reflux fluid when lying flat in bed.
A hiatus hernia may also cause a feeling of food trapping in the oesophagus, or fullness after eating a small amount. In some people in whom a large portion of the stomach is trapped in the chest, eating a large meal may cause breathlessness or palpitations (racing or irregular heartbeat) as the enlarged stomach puts pressure on the lungs or heart.
What can I do about it?
Minor symptoms may be controlled by simple measures. Don't eat large meals or drink large volumes of fluid for a few hours before going to bed. Sleep with the head of the bed propped up so that you are not lying flat. Avoid caffeine, alcohol and smoking - all can make reflux worse. Being overweight is one of the major causes of reflux - lose a few kgs and your symptoms will be considerably better.
If you do not get relief from these simple measures, or if your symptoms are more severe and constant, you should consult your GP to ensure that there is nothing else that could be causing them. In particular, the sensation of food sticking should be investigated early to exclude more serious, though rare, conditions.
If the simple measures don't work then there are plenty of tablets your GP can prescribe - some are also available over the counter. From simple alkaline products to counteract acidity (e.g. 'Rennies') to more advanced drugs that reduce the stomach's production of acid (e.g omeprazole).
For some people, even tablets are unable to control symptoms - in which case surgery may be considered. In the past, surgery to repair a hiatus hernia was a major procedure involving an incision or cut in the upper abdomen, or even chest. Now it is almost always performed by keyhole (laparoscopic) surgery and requires only a day or so in hospital. The operation aims to narrow the widened hiatus by stitching together part of the diaphragm muscle, and to re-create the valve effect of the upper stomach and lower oesophagus.
This is generally a safe and straightforward procedure - however, any surgery carries some risk and you should discuss this in full with an experienced upper gastro-intestinal surgeon before electing to undergo such surgery. Results are generally very good - with most people experiencing a significant improvement in symptoms and no further need for medication.
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