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Hiatal Hernias and GERD: Understanding the Link

If you have GERD (gastroesophageal reflux disease), you know how unpleasant the symptoms can be. The heartburn, regurgitation and chest discomfort can make you feel miserable after eating and keep you awake at night.

What you may not know is that a hiatal hernia could be causing your GERD symptoms. 

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of your stomach pushes through your diaphragm and into your chest.

Here’s how it can happen: You have a muscle called the lower esophageal sphincter (LES) at the connection where your stomach meets your esophagus. This muscle helps close the connection when you eat so stomach acid doesn’t enter the esophagus. 

“With a hiatal hernia, these muscles are stretched out, so they can’t close the connection properly,” said Kumash Patel, MD, a surgeon with Banner Health. 

Small hiatal hernias are common and usually don’t cause noticeable symptoms. 

But larger hiatal hernias can be uncomfortable. They can hold undigested food and stomach acid, which can damage your esophagus over time. If you have one, you may notice:

  • Heartburn — a burning pain in the chest
  • Chest pain or discomfort
  • Burping or hiccupping
  • Food regurgitation, which can leave a bitter or sour taste in your mouth
  • A sore or irritated throat
  • Hoarseness
  • Bad breath
  • Abdominal (belly) pain or discomfort
  • Upset stomach
  • Trouble swallowing
  • Shortness of breath
  • Difficulty breathing
  • Feeling full soon after you start eating

Many of these symptoms are the same symptoms you would have with GERD. In fact, hiatal hernias can cause GERD. 

Sometimes, people ignore hiatal hernias for a long time because they think GERD is causing their symptoms. So how do you know which condition is behind your discomfort? 

Diagnosing GERD and hiatal hernia

“If you have persistent symptoms, you should seek medical care,” Dr. Patel said. A health care provider can diagnose your condition and help you develop a treatment plan.

Your doctor will ask about your symptoms and what makes them better or worse. They may recommend certain tests:

  • CT scan, to look for structural abnormalities.
  • Upper endoscopy uses a thin, flexible tube with a camera to look inside your esophagus and stomach.
  • Acid probe, which monitors when, and for how long, stomach acid enters your esophagus. 
  • Barium swallow, where you drink a liquid that shows up on an X-ray so your provider can see your stomach and esophagus better.
  • Pressure study, which checks the pressure in your esophagus when you swallow.

The results of these tests can help your provider make an accurate diagnosis.

Types of hiatal hernias

Sliding hiatal hernias are the most common type. They account for about 95% of all hiatal hernias. They move as you eat and swallow, so your symptoms are more severe when the herniated part of the stomach bulges further through your diaphragm. 

In rolling hiatal hernias, part of the stomach sits next to the esophagus. It doesn’t move up and down. These hernias can become dangerous when they get larger. That’s because they can compress the esophagus or cut off blood flow to the stomach.

Other types of hiatal hernias are very rare.

Treating GERD and hiatal hernia

You can treat both GERD and hiatal hernia with lifestyle changes and medication. Here are some steps you can take:

  • Don’t lie down for at least three hours after eating — don’t eat close to bedtime. 
  • Have smaller, more frequent meals instead of large meals. If you have a large meal, eat it earlier in the day.
  • Pay attention to foods that make your symptoms worse. Many people have trouble with fatty foods, onions, mint, chocolate, alcohol, coffee, tea, cola, spicy food and acidic food like tomato and citrus. 
  • Elevate the head of your bed so you’re not lying flat while sleeping. 
  • Lose weight if you’re overweight since fat in the abdomen puts pressure on the stomach.
  • Quit smoking since smoking can weaken the lower esophageal sphincter.

Over-the-counter (OTC) treatment options include:

  • Antacids like Tums and Rolaids, which neutralize stomach acid.
  • Medications like Pepcid AC and Tagamet HB lower the amount of acid your stomach produces.
  • Medications like proton pump inhibitors such as Prilosec OTC, Nexium and Prevacid lower acid production and help your esophagus heal.

You should tell your provider if you are taking medication for your symptoms. If OTC medicines aren’t working, your doctor can suggest prescription options.

If you have a hiatal hernia, surgery might be your best treatment. “Surgery is typically performed using minimally invasive techniques, such as laparoscopic surgery. Most people go home the same day or stay in the hospital just one night,” said Dr. Patel. “Surgery is successful more than 90% of the time, and after surgery you don’t need to take medication anymore.”

For GERD, your doctor may want you to consider a transoral incisionless fundoplication (TIF) procedure. With it, surgeons access your esophagus through your mouth and fasten tissue folds to stop acid reflux.

Working with your health care team, you can explore treatment options and find what works best for you.

The bottom line

GERD and hiatal hernias can cause symptoms such as heartburn, upset stomach and food regurgitation. If you have these symptoms, talk to your doctor or reach out to a Banner health care provider. With proper care, you can reduce or eliminate your symptoms and improve your quality of life.

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