How To Treat a Hiatal Hernia
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Medically reviewed by Robert Burakoff, MD
A hiatal hernia occurs when the upper portion of your stomach bulges up into your chest through an opening in the diaphragm. The diaphragm is a thin muscle that separates your abdomen from your chest and helps prevent stomach acid from moving up into the esophagus (a tube that connects your mouth to your stomach). But when you develop a hiatal hernia, stomach acid can easily enter your esophagus, causing uncomfortable symptoms like heartburn, dry cough, or nausea.
If you don't have symptoms, you may not need any treatment at all. But in most cases, hiatal hernias require some form of treatment. The treatment options for both types of hiatal hernia (sliding and paraesophageal) are the same. The most common treatments available involve lifestyle changes and medications. More severe cases may require surgery to repair the hernia.
Some primary care providers treat hiatal hernias, but they may refer you to a gastroenterologist for care, depending on the severity and size of the hernia. Gastroenterologists (doctors specializing in diagnosing and treating problems with the digestive system) oversee hiatal hernia treatment and can recommend a treatment plan that is right for you.
Lifestyle Changes
Adjusting your diet and sleep habits can help you manage hiatal hernia symptoms by reducing the production of stomach acid and preventing acid from leaking into your esophagus. Lifestyle modifications that can help minimize your symptoms include:
Trying a balanced diet: Eating nutritious foods can help reduce stomach acid production and improve digestion. This includes eating plenty of fruits, vegetables, lean proteins, fiber, and whole grains.
Eating smaller, more frequent meals: Having smaller meals throughout the day rather than three large meals can help reduce pressure on the diaphragm.
Avoiding trigger foods: Some foods can trigger acid reflux and heartburn. Common trigger foods include caffeine, alcohol, chocolate, fatty foods, spicy foods, and acidic foods (e.g., citrus fruits and tomatoes).
Limiting meals before bed: Eating too close to bedtime can increase the risk of stomach acid leaking into the esophagus and causing heartburn. It is best to avoid eating for at least three hours before bedtime to allow your body to digest food properly before you sleep.
Elevating your head while sleeping: Raising the head of your bed by eight inches can help prevent stomach acid from moving into the esophagus. You can do this by placing a wedge under your mattress or using a special pillow that helps elevate your head while you sleep.
Quitting smoking: Smoking can weaken the lower esophageal sphincter, which makes it easy for stomach acid to flow into the esophagus. As a result, you can experience worsening acid reflux and heartburn.
Medications
Medications can help control symptoms by reducing stomach acid production and neutralizing existing acid in your digestive system. Depending on how severe your symptoms are, your healthcare provider or gastroenterologist can either recommend over-the-counter (OTC) or prescription drugs.
Over-the-Counter
If you have mild symptoms, your healthcare provider will likely recommend OTC medications to control acid reflux and heartburn.
Antacids: Antacids neutralize stomach acid, providing quick relief from acid reflux and heartburn. They are available in liquid and tablet form. Examples include Mylanta (aluminum hydroxide) and Tums (calcium carbonate).
Histamine-2 (H2) blockers: H2 blockers decrease stomach acid production to minimize acid reflux. They take about one to three hours to work and may interact with other medicines, so talk to your healthcare provider before using these pills. Examples include Pepcid AC (famotidine), Tagamet HB (cimetidine), and Axid AR (nizatidine).
Proton pump inhibitors (PPIs): OTC proton pump inhibitors are helpful for frequent heartburn. It can take about one to four days for them to become effective. You should only use these medications for 14 days at a time and no more than three times a year. Nexium 24HR (esomeprazole), Prevacid 24HR (lansoprazole), and Prisolec OTC (omeprazole magnesium) are the most common PPIs available.
Prescription
If OTC options are ineffective, your healthcare provider may prescribe medications to control your symptoms. Prescription medications for a hiatal hernia are stronger versions of OTC treatment options and may include the following medications:
Proton pump inhibitors (PPIs): These medicines are the most effective treatment for hiatal hernia symptoms. They suppress the production of stomach acid to help prevent acid reflux and heartburn. Your healthcare provider may prescribe Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), Protonix (pantoprazole), Aciphex (rabeprazole), or Dexilant (dexlansoprazole).
Histamine-2 (H2) blockers: H2 blockers bind to histamine receptors in your stomach to reduce stomach acid production and prevent acid reflux. They work similarly to PPIs but tend to be less effective—though they may be a good option for people who do not tolerate PPIs well. Your healthcare provider may prescribe Pepcid AC (famotidine), Tagament HB (cimetidine), and Axid AR (nizatidine).
Complementary and Alternative Medicine (CAM)
Complementary therapies may also help control symptoms of acid reflux. Some people like to use these methods alongside conventional medical treatments, like lifestyle changes or medication. These options may help you find relief from your symptoms. However, it's worth noting that CAM therapies do not cure a hiatal hernia and should not replace treatments your healthcare provider recommends.
If you're interested in trying CAM treatments, consider the following:
Acupuncture: Acupuncture is a traditional Chinese medicine practice that involves inserting thin needles into specific points on your body. Research suggests that acupuncture may strengthen the lower esophageal sphincter and provide short-term relief for heartburn. Acupuncture is safe and generally well-tolerated with few side effects.
Licorice root: Licorice root has a long history of use in treating digestive problems. Research suggests that supplements containing licorice root extracts or licorice root tea may support your esophageal lining and help protect against the effects of acid reflux. However, some evidence shows that licorice root is associated with an increased risk of high blood pressure, low potassium levels, and muscle weakness. Talk to a healthcare provider before using licorice, especially if you have underlying medical conditions.
Surgeries and Procedures
When lifestyle modifications and medications are not enough to treat your symptoms, your healthcare provider may recommend surgery. Of the two types of hernias, paraesophageal hernias often require surgical repair because they pose a higher risk of complications.
There are several surgical treatment options for hiatal hernia. Which surgical procedure healthcare providers recommend depends on the type, size, and severity of your hernia.
Nissen Fundoplication
A Nissen fundoplication is the most common surgical procedure for treating hiatal hernias. This surgery is a minimally invasive procedure—meaning that your surgeon doesn't need to make large cuts into your skin to treat the hernia.
Instead, your surgeon will make small incisions in your abdomen and use a thin, flexible tube equipped with a camera (laparoscope) to perform the surgery. During the procedure, the surgeon will wrap the upper part of your stomach around the lower esophagus to tighten the lower esophagal sphincter (LES) and prevent stomach acid from backing up into the esophagus.
Repair Surgery
Hiatal hernia repair surgery involves placing the stomach back into its proper position and reducing the size of the diaphragm's opening. During the procedure, your surgeon will reposition your stomach and use sutures (stitches) and surgical mesh to reduce the size of the diaphragm's opening and reinforce the area to prevent your hernia from coming back. Surgeons may perform this surgery in one of two ways:
Laparoscopic surgery: Makes small incisions in the abdomen while using a laparoscope (a thin, flexible tube with a camera) to repair the hernia. This approach typically results in less pain, shorter recovery times, and smaller scars than traditional open surgery.
Open surgery: Involves surgeons making a large incision in the abdomen or chest to access and repair the hernia. Open surgery may be necessary for complex or very large hernias.
Collis-Nissen Gastroplasty
Collis-Nissen gastroplasty is a type of hiatal hernia surgery that lengthens the esophagus and tightens the lower esophageal sphincter (LES). This helps prevent stomach acid from leaking into the esophagus. This procedure is recommended for people with large or complex hiatal hernias or a short esophagus.
During the procedure, the surgeon makes several small incisions in the abdomen and inserts a laparoscope equipped with surgical tools and a camera. Your surgeon will divide the stomach lengthwise, create a tube from the upper portion of the stomach, and wrap the tube around the LES before securing it into place using surgical staples.
Living With and Managing Hiatal Hernia
Many people with a hiatal hernia have no symptoms. Those who experience symptoms can often manage the condition with lifestyle adjustments and medication. Treating a hiatal hernia can help prevent complications, such as esophagitis (narrowed esophagus), difficulty breathing if the hernia becomes large enough to press on the diaphragm, or reduced blood supply to the herniated portion of the stomach.
Being proactive about your health by making simple adjustments to your dietary habits, such as eating smaller, more frequent meals throughout the day and avoiding foods that trigger your symptoms can help reduce discomfort and improve your quality of life. But, if at-home remedies aren't helping, talk to your healthcare provider for support. They may recommend different treatments or surgery to repair the hernia and reduce symptoms.
A Quick Review
A hiatal hernia is a condition that causes the upper part of your stomach to push up through the diaphragm. The enlarged opening in the diaphragm allows stomach acid to flow into the esophagus, leading to symptoms like acid reflux, heartburn, and chest pain.
Fortunately, several treatment options can reduce symptoms. Lifestyle modifications and medications are the first-line treatments for hiatal hernia. If these treatments are ineffective or in cases of complications or large hernias, surgery may be necessary to repair the hernia. The right treatment for you depends on the severity of your symptoms, hernia size, and overall health.
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