Hiatal Hernia Overview (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
In this Article
- Hiatal hernia definition
- What causes a hiatal hernia?
- Is there one more than one type of hiatal hernia?
- What are the signs and symptoms of a hiatal hernia?
- How is hiatal hernia diagnosed?
- What is the treatment for hiatal hernia?
- Hiatal hernia medications
- Lifestyle changes
- Hiatal hernia surgery
- Find a local Gastroenterologist in your town
Hiatal hernia medications
Proton pump inhibitor medications are commonly used to decrease acid production. These include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium).
- Lifestyle changes may include elevating the head of the bed when sleeping to allow gravity to prevent acid from refluxing into the esophagus.
- Small frequent meals may help instead of eating two or three larger meals a day.
- Some foods that should be avoided include spicy, greasy foods, onions, tomatoes and citrus fruits, however, most individuals are generally aware of the foods that trigger heartburn symptoms and avoid them.
Hiatal hernia surgery
With the development of proton pump inhibitor medications, medical therapy has decreased the necessity of surgery for sliding hiatal hernias, and it is often only recommended for people who have failed aggressive drug treatment or who have developed complications of GERD like strictures, ulcers, and bleeding or those with repeated pneumonia form aspiration.
Patients with paraesophageal hernias often have no symptoms, and surgery is required only if the hernias become incarcerated and become stuck in the diaphragmatic hiatus or rotate to cause a volvulus. While this is more commonly seen in older people, paraesophageal hernias also may occur as a congenital condition in neonates and infants.
Most often, the surgery is done as a minimally invasive procedure using a laparoscope. While there are different techniques (Nissen, Belsey or Hill), the results are similar and the option recommended is the one the surgeon feels most comfortable performing in a specific situation.
Kohn GP, et al. Guidelines for the Management of Hiatal Hernia. Society of American Gastrointestinal and Endoscopic Surgeons. April 2013
Society of American Gastrointestinal and Endoscopic Surgeons. Guidelines for the Management of Hiatal Hernia.
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