Gastroesophageal reflux disease (GERD) refers to the presence of stomach contents in the esophagus. Hiatal hernia occurs when the stomach moves into the chest through the diaphragm’s opening. Hiatal hernia may result from long-term GERD. Additionally, gastroesophageal reflux can be a symptom of hiatal hernia.
What is Gastroesophageal Reflux?
Gastroesophageal reflux, or GERD, is the presence of stomach contents in the esophagus. A weakness (relaxation) in the valve between the esophagus and stomach allows stomach acid to irritate the esophagus.
GERD affects many people and often manifests as heartburn. In most cases, heartburn can be relieved by diet changes and lifestyle modifications.
Six Tips for Controlling Heartburn
- Avoid foods and drinks that irritate the esophagus and may further weaken the muscle valve. These include fried and fatty foods, mint, chocolate, alcohol, coffee, citrus fruits and juices, and tomato products.
- Lose weight if you’re overweight.
- Stop smoking.
- Elevate your head when lying down by raising the head of your bed.
- Avoid lying down for two to three hours after eating.
- Take over-the-counter antacids.
Reducing portion sizes during meals can also improve symptoms. Eating meals at least two to three hours before bedtime may reduce reflux by allowing stomach acid to decrease and the stomach to partially empty.
What Role Does Hiatal Hernia Play in Causing Reflux?
Heartburn occurs when the lower esophageal sphincter (LES) is not as strong as normal. This allows stomach acid to move back into the esophagus and cause discomfort.
Hiatal hernia is diagnosed when the stomach moves into the chest through the diaphragm’s opening. (The diaphragm separates the abdominal organs from the thoracic cavity.) The opening in the diaphragm acts as an additional barrier to acid reflux.
Hiatal hernia may not require treatment unless there is a risk of strangulation or it complicates GERD.
What are the Goals of Reflux Treatment?
- Eliminate the patient’s symptoms.
- Heal esophagitis.
- Manage or prevent the recurrence of reflux.
- Prevent complications.
What Tests are Used to Diagnose Reflux-Related Issues?
- Barium swallow (upper GI series with barium contrast)
- Gastroscopy or Upper endoscopy (a flexible tube with a camera to examine the digestive system)
- 24-hour pH monitoring (measures the amount of acid refluxing from the stomach into the esophagus)
- High-resolution esophageal manometry (assesses the function of the lower esophageal sphincter)
- Gastric emptying study
Do GERD and Hiatal Hernia Require Surgery?
A small number of patients may require surgery due to poor response to medical treatment. While GERD and hiatal hernia can limit daily activities, most people find relief by understanding the causes and following appropriate treatment.
Can Surgery Stop GERD?
Laparoscopic (minimally invasive) repair of hiatal hernia and reflux, called Nissen fundoplication, has been shown to be 90% effective in most patient populations. The surgery strengthens the lower esophageal sphincter. It requires general anesthesia and typically involves a one-day hospital stay. Post-surgery, patients no longer need long-term treatment with antacids or acid-suppressing medications.
