More than acid reflux? Doctor says how to spot hiatus hernia and how to treat

Know if your frequent acid reflux and bloating are just common gut issues or signaling a more serious condition like a hiatus hernia.

If you frequently get uncomfortable heartburn or feel very full after eating meals and are blaming it on your food, you may be in the dark. Bloating, burning sensation in the chest and abdomen may be common signs of acidity. But at times, it can also be from underlying issues. One of them is hiatus hernia. Hiatus hernia often presents with symptoms that resemble common, everyday gut issues. Dr Aparna Govil Bhasker, Consultant Bariatric and Laparoscopic Surgeon at MetaHeal - Laparoscopy and Bariatric Surgery Centre, Mumbai, shared how the condition affects people over 50.

Explaining the prevalence and the contributing factors, she said, "55 to 60% individuals above the age of 50 years may be suffering from a hiatus hernia. Out of these 9 to 10% are symptomatic. Hiatus hernia can be congenital or acquired. Conditions that increase the pressure in the abdomen are contributing factors are obesity, pregnancy, chronic constipation, COPD, etc. Other factors such as trauma, previous surgeries and genetics can also play a role in its development. The main reason is muscular weakness.

Breaking down what actually happens inside the body, Dr Aparna explained what happens in the gut during hiatus hernia. It often goes unnoticed as the signs are similar to everyday gut issues like acid reflux or heartburn.

She shared,“In a hiatus hernia, the upper part of the stomach pushes through the diaphragmatic opening into the chest, compromising the muscular valve at the lower end of the food-pipe. This loosening and relaxation of the valve may allow contents and acid from the stomach to reflux into the food pipe, leading to gastroesophageal reflux disease (GERD). Small hiatal hernias are often asymptomatic and are usually treated with medications. Large hiatal hernias usually require surgery in the form of a laparoscopic fundoplication. Most small hiatus hernias don’t have any signs and symptoms when they are small.”

Abdominal pain is one of the signs of a larger hiatal hernia.

• Belching, vomiting
• Heartburn and acid reflux
• Abdominal or chest pain
• Difficulty in swallowing
• Feeling very full, especially after meals
• Passing black stools or vomiting blood, which at times is an indication of gastrointestinal bleeding
• Change in voice

How to prevent and treat

• Lifestyle modification is the first line of treatment. Since most hiatal hernia symptoms stem from acid reflux, dietary modifications can help significantly.
• Eating smaller, more frequent meals instead of three large ones, avoiding heavy meals or snacks close to bedtime, quitting smoking are all simple but effective measures.
• Patients are also advised to avoid lying down or bending over soon after meals to prevent heartburn.
• Medications play an important role in managing symptoms of hiatal hernia, especially those related to acid reflux. Antacids are commonly used to neutralise stomach acid, while H2-receptor blockers help reduce acid production. Proton pump inhibitors (PPIs) are another effective option, as they block acid production completely, giving the food pipe time to heal.

When surgery may be needed

• Surgical repair is needed when the patients are unable to stop medical treatment, if there is no relief despite medical management.
• When the patient develops complications like oesophageal ulcers, reflux in the windpipe, Barrett's oesophagus, etc.
• Laparoscopic fundoplication is a commonly performed minimally invasive surgery in such cases, which leads to symptom relief and also prevents future complications. A fundoplication involves bringing back the herniated contents from the chest into the stomach, tightening the loose valve and creating a wrap of the stomach.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.