Hiatus Hernia

A hiatus hernia occurs when part of the stomach slides up into the chest cavity where the oesophagus passes through the hole (hiatus) in the diaphragm.  These hernias are common in people over 50 but, apart from some heartburn and pain, rarely cause complications.  If the heartburn goes on for a long time or becomes severe, the condition is known as gastro-oesophageal reflux disease (GORD).

The exact cause of hiatus hernia is not known.  It is commonly associated with the stretching of the diaphragm muscles due to increased pressure in the abdomen caused by:  

• being overweight or obese
• pregnancy
• having a long-term cough (e.g. smoker's cough) 
• straining to pass urine as with men who have prostate trouble 

Diagnosis is normally by barium swallow or endoscopy:

• a barium meal is swallowed and the liquid followed down the oesophagus by continuous x-raying 
• a long, thin tube containing a light source and a tiny camera (endoscope) is passed through the mouth or nose and swallowed.  Tissue samples (biopsy) may be taken for closer examination.

Changes in lifestyle can reduce the symptoms and prevent further problems occuring:

• eating frequent small meals
• reducing the amount of spicy foods, coffee and alcohol taken
• not eating just before going to bed
• wearing loose-fitting comfortable clothes
• losing weight if overweight or obese
• stopping smoking
• sleeping with several pillows or raising the head end of the bed by about 10cm.

Antacids or acid-blocking medicines from a chemist give relief.  If indigestion occurs regularly several times a week, a GP should be consulted who may prescribe more powerful medication.  Rarely, keyhole surgery may be needed to push the stomach back into its correct position and repair the gap in the diaphragm.