Hiatus hernia - Treatment 

Treating a hiatus hernia 

Weight loss tips

People talk about how they have successfully lost weight and an NHS dietitian offers useful tips.

Media last reviewed: 14/11/2013

Next review due: 14/11/2015

Hiatus hernia medicines information

Read more about the medicines used to treat hiatus hernia

Treatment for a hiatus hernia is usually only necessary if it's causing problems.

In most cases, people with a hiatus hernia only experience problems if the hernia causes gastro-oesophageal reflux disease (GORD). GORD can cause symptoms such as heartburn and an unpleasant taste in your mouth.

Lifestyle changes and medication are the preferred treatments, although surgery may be used as an alternative to long-term medication or if other treatments are ineffective.

Lifestyle changes

A number of self-care techniques may help relieve symptoms of GORD caused by a hiatus hernia. These include:

  • eating smaller, more frequent meals rather than three large meals a day
  • avoiding lying down (including going to bed) for at least three hours after eating or drinking
  • avoiding drinking during the night
  • removing certain foods from your diet if you think they make your symptoms worse
  • avoiding alcohol, caffeine, chocolate, tomatoes, fatty foods, spicy foods and acidic food or drinks (such as citrus fruit juice) if they make your symptoms worse
  • avoiding bending over or stooping, especially after eating or drinking
  • raising the head of your bed by around 20cm (8 inches) by placing a piece of wood or blocks under it – do not use extra pillows because this may increase pressure on your abdomen

If you are overweight, losing weight may help reduce the severity and frequency of your symptoms.

If you smoke, consider stopping. Tobacco smoke can irritate your digestive system and may make your symptoms worse.

Read more about good foods to help your digestionlosing weight and stopping smoking.

Medication

A number of different medications can be used to treat symptoms of hiatus hernia. These are described below.

Antacids

Antacid medicines can relieve some of the symptoms of hiatus hernia. They come in liquid or tablet form and can be swallowed or chewed. They help neutralise stomach acid when they reach the oesophagus and stomach by making it less acidic.

However, antacid medicines don't work for everyone. They're not a long-term solution if symptoms persist or you are in extreme discomfort. 

Antacids should not be taken at the same time as other medicines because they can stop other medicines from being properly absorbed by your body. They may also damage the special coating on some types of tablets. Ask your GP or pharmacist for advice.

Alginates

Alginates are an alternative medicine to antacids. They work by producing a protective coating that shields the lining of your stomach and oesophagus from the effects of stomach acid.

H2-receptor antagonists

In some cases, a medicine known as an H2-receptor antagonist (H2RA) may be recommended if a hiatus hernia is causing GORD. Examples of H2RAs include cimetidinefamotidine and ranitidine.

H2RAs block the effects of the chemical histamine, which your body uses to produce stomach acid. H2RAs therefore help reduce the amount of acid in your stomach.

Side effects of H2RAs are uncommon. However, possible side effects may include diarrhoea, headaches, tiredness and a rash.

Some H2RAs are available over the counter at pharmacies. These types of HR2As are taken in a lower dosage than the ones available on prescription. Ask your GP or pharmacist if you are not sure whether these medicines are suitable for you.

Proton-pump inhibitors (PPIs)

Your GP may prescribe a medication called a proton-pump inhibitor (PPI). PPIs work by reducing the amount of acid produced by your stomach. Examples of the PPIs you may be prescribed include omeprazole, lansoprazole, rabeprazole and esomeprazole.

Most people tolerate PPI well and side effects are uncommon. When they do occur they are usually mild and may include headaches, diarrhoea, feeling sick, or constipation.

To minimise any side effects, your GP will prescribe the lowest possible dose of PPIs they think will be effective. You should let your GP know if the prescribed dose of PPIs doesn't work. A stronger dose may be needed. 

Prokinetics

If your symptoms are not responding to other forms of treatment, your GP may prescribe a short-term dose of a prokinetic. Examples of prokinetic medicines include domperidone and metoclopramide.

Prokinetics speed up the emptying of your stomach, which means there is less opportunity for acid to irritate your oesophagus.

A small number of people who take prokinetics have what is known as extrapyramidal symptoms. Extrapyramidal symptoms are a series of related side effects that affect your nervous system and can include:

  • muscle spasms
  • problems opening your mouth fully
  • a tendency to stick your tongue out of your mouth
  • slurred speech
  • abnormal changes in body posture

If you have the above symptoms while taking prokinetics, stop taking them and contact your GP or out-of-hours doctor immediately. They may recommend you stop taking them. The symptoms should stop within 24 hours of the medicine being withdrawn.

Prokinetics are not usually recommended for people under the age of 20 because of an increased risk of extrapyramidal symptoms. 

Surgery

Surgery is usually only recommended for a sliding hiatus hernia if the problem fails to respond to lifestyle changes and medication.

You may also wish to consider surgery if you have persistent and troublesome symptoms but do not want to take medication on a long-term basis.

Prior to surgery you may need further investigations to check how well the oesophagus moves (manometry) and how much acid is being refluxed (24-hour oesopageal pH studies).

Laparoscopic nissen fundoplication (LNF)

A procedure called a laparoscopic nissen fundoplication (LNF) is one of the most common surgical techniques used to treat GORD and sliding hiatus hernias.

LNF is a type of keyhole surgery that involves making a series of small cuts in your abdomen. Carbon dioxide gas is used to inflate your abdomen to give the surgeon room to work in.

During LNF, the stomach is put back into the correct position and the diaphragm around the lower part of the oesophagus is tightened. This should prevent any acid moving back out of your stomach.

LNF is carried out under general anaesthetic, so you will not feel any pain or discomfort. The surgery takes 60 to 90 minutes to complete.

After having LNF, most people can leave hospital once they have recovered from the effects of the general anaesthetic. This is usually within two to three days. Depending on the type of job you do, you should be able to return to work within three to six weeks.

For the first six weeks after surgery it is recommended you only eat soft food, such as mince, mashed potatoes or soup. Avoid eating hard food that could get stuck at the site of the surgery, such as toast, chicken or steak.

Common side effects of LNF include difficulties swallowing (dysphagia), belching, bloating and flatulence.

These side effects should resolve over the course of a few months. However, in about 1 in 100 cases they can be persistent. In such circumstances, further corrective surgery may be required.

Para-oesophageal hiatus hernia

If you have a para-oesophageal hiatus hernia, where the stomach pushes up through the hole in the diaphragm next to the oesophagus, surgery may be recommended to reduce the risk of the hernia becoming strangulated.

See complications of hiatus hernia for more information.

Page last reviewed: 09/04/2013

Next review due: 09/04/2015

Ratings

How helpful is this page?

Average rating

Based on 376 ratings

All ratings

Add your rating

Comments

The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Paul Maybin said on 10 August 2014

I am hoping to get a referral for surgery. I have taking the usual medications for HH for two years yet the symptoms are still present. The worst is when it feels very tight in my chest with palpitation type heart beats. Very frightening.....I am going to start the process of trying to get this sorted now but it seem surgical referrals are hard to come by.

Report this content as offensive or unsuitable

boncon said on 05 November 2013

Female, 61. Diagnosed with 'small hiatus hernia' following endoscopy 5 weeks ago. No reflux/ indigestion experienced. Constant discomfort from feeling of pressure in diaphragm mid chest and also intermittent left side upper chest pain. Lower than average weight, fit healthy fitness trainer, non smoker, healthy eater, rarely drink alcohol. Doctors advice? Take Omeprazole for a month and come back? Why? I do not have reflux I am in discomfort and losing weight due to the lack of motivation to eat for fear of more discomfort. What should be my next step? Back to GP and insist on referral to specialist? Who knows? Becoming worried that no one will care.

Report this content as offensive or unsuitable

Romadean said on 29 April 2013

Regarding the above post re waiting list for months, surely as an ex nurse should be aware of the Options that I understand to be available. If the NHS cant offer an operation within 20 weeks I believed it was mandatory under their Charter to offer an alternative through Private Funding. Do make a noise about this. She who shouts the loudest wins!
Having said that I had my Open Nissen Fundoplication last week, so early days to report back!!
Watch this space.........

Report this content as offensive or unsuitable

paulpop said on 19 March 2013

well ive been suffering from hiccops for the last 3 days went to see my gp (who was on holiday) so saw another gp who asked why i wasnt taking any medication for the hernia. i replied nobody had told me i had one. so he gave two perscriptions one stop hiccups and another to stop acid reflux. then ordered a chest xray,blood test and an ecg.and then apologised for my doctor who knew i had a hernia since 2001 but decided not to tell me!

Report this content as offensive or unsuitable

druidic said on 15 March 2013

I have had a large sliding hiatus hernia for the past five years and oesophagitis. As previous patients have commented I have a foul taste in my mouth all the time also severe chest pain and vomiting frequently occurs after meals. Am on a double dose of lansoprazole and also have to take gaviscon 4 times a day for the reflux. I have been feeling constantly dizzy and having falls for the last five months so was referred to hospital for a series of tests including chest x-ray as cause was unknown. Earlier this week the consultant who ordered the tests phoned to inform me that my x-ray showed my hernia had become worse was becoming incarcerated with risk of strangulation. He also felt that this could be causing my dizzyness (in part at least). I was told to go to my G.P and inform him that an urgent clinical review should be carried out and that the consultant would send a letter confirming this in a few days. My doctor was most unsympathetic I was told in no uncertain terms that I had cost the nhs/surgery enough money and that if what I said was true he may put me on a non urgent list for gastroscopy (I had one two years ago and should not require another). In a lot of discomfort and feeling totally demoralised what a state of affairs when a consultant tells you to take immediate action and a G.P dismisses you out of hand. Even more worrying if the other comments are correct.

Report this content as offensive or unsuitable

Mel1990 said on 12 February 2013

I was diagnosed with a hiatus hernia in December through a endoscopy and was told to carry on taking lansoprazole which does not work, I have hiccups or what I say are hiccups all the time and keep getting pain at the top of my stomach and lately the pain is getting worse after and I have been feeling really sick as food has got stuck. I don't know what to do as the doctors just keep giving me more tablets which don't work.

Report this content as offensive or unsuitable

jeanhartley said on 23 January 2013

Diagnosed with a very large upper abdominal hernia and on the so-called urgent list for surgery for 3 months having been referred urgently 5 months ago.
Advised to go to A&E as it is partially strangulating. No planned op date for next few months! This is how they treat retired nurses!!!! Passive euthanasia?

Report this content as offensive or unsuitable

Romadean said on 01 December 2012

I did read that long term use of Omeprazole is not advised! Do check this out with your GP asap.

Report this content as offensive or unsuitable

Harrrison1 said on 29 September 2012

I have a hiatus hernia. Nowhere does it mention the foul taste constantly in one`s mouth and the general debilitation it causes. I take a double dose of omeprazole .I am also prescribed metaclopramide to control the nausea but it makes me feel terrible, I have tried many different anti nausea drugs. I find the diet consists of small portions of soft food and warm milk or water sometimes helps. One needs to be aware of the lack of essential vitamins etc in such a diet.

Report this content as offensive or unsuitable

Soay said on 11 October 2011

Under treatment it gives change of lifestyle, but nowhere can details be found of what changes anyone sufferinf from a hiatus hernia might make eg: diet etc.

Report this content as offensive or unsuitable

Eat right for your digestion

How to eat and drink to ensure a good digestion, including foods to avoid and which ones to fill up on.