How a Hiatal Hernia Is Treated

A hiatal hernia is a condition in which the upper part of your stomach bulges through an opening in your diaphragm. Different types of hiatal hernia, such as a paraesophageal hernia, can require different treatments. A sliding hiatal hernia is the most common type.

The diaphragm is the thin muscle that separates your chest from your abdomen. When part of the lower esophagus (the tube that runs from the mouth into the stomach) pokes into the chest through the diaphragm, stomach acid can come up into the esophagus, which can lead to heartburn and gastroesophageal reflux disease (GERD).

Symptoms may include:

  • Heartburn
  • Problems swallowing
  • A dry cough
  • Bad breath
  • Nausea and/or vomiting
  • Breathing problems
  • The wearing away of your teeth

Some people don’t experience any symptoms and won’t require treatment, but usually, hiatal hernia treatment involves lifestyle modifications and medication to relieve symptoms or, in some cases, surgery to repair the hernia.

This article discusses how hiatal hernias are treated, including at-home lifestyle changes and medications to improve symptoms. It also covers what procedures are available for more serious cases.

Key lifestyle changes for hiatal hernia relief.
Laura Porter / Verywell

Risk Factors for Hiatal Hernia

Hiatal hernia and GERD are more common in people who are:

  • Over age 50
  • Smokers
  • Overweight or obese

This may be due to excessive stress on the stomach (in the case of obesity) or weak supporting tissue between the esophagus and stomach.

How Is a Hiatal Hernia Treated?

Some people don't experience symptoms or need treatment and most people get relief from lifestyle changes and medication. People with more serious conditions may need surgery. The treatment will depend on factors including the type of hiatal hernia. These types include:

  • Sliding hernias, often associated with GERD
  • Paraesophageal hernias, with the hernia adjacent to the esophagus
  • A mixed combination of sliding and paraesophageal hernias

A fourth type of hernia occurs when another organ, like the colon, pushes through into the thoracic cavity instead of the stomach.

Home Remedies and Lifestyle

To overcome reflux symptoms, you need to address the underlying causes. Several key lifestyle changes can help minimize your symptoms:

  • Weight loss relieves the abdominal pressure that can cause a hernia.
  • Follow a low-fat, high-fiber diet to help reduce constipation and stomach acid production.
  • Get enough fluids by drinking at least eight cups of water daily. This will help reduce the risk of constipation and dilute acid in your stomach.
  • Avoid trigger foods that can cause heartburn, including high-fat and fried foods, spicy foods, tomato-based sauces, citrus, garlic, onion, carbonated drinks, caffeine, and alcohol.
  • Quit smoking because smoking relaxes the LES, allowing food and acid to reflux more easily.
  • Eat several smaller meals throughout the day instead of a few large meals and avoid eating late in the day.
  • Elevate your head while sleeping using pillows or a foam wedge to raise your head 6 to 8 inches.

Over-the-Counter Medications

Over-the-counter (OTC) medication is a first-line defense against heartburn and acid reflux that occur with hiatal hernias. Some of the more commonly used medications include antacids, Histamine 2 (H2) receptor blockers, and proton pump inhibitors (PPIs).

These medicines can be helpful in reducing symptoms as you work on addressing the root cause of your reflux and take steps to make lifestyle changes.

OTC drugs to treat acid reflux are considered safe for intermittent use but may cause problems if daily use is excessive. If OTC drugs aren't relieving your symptoms, talk with your healthcare provider about other treatment options.

Antacids

Antacids work by neutralizing stomach acid with ingredients like aluminum hydroxide and magnesium hydroxide. Common brands include:

  • Tums
  • Rolaids
  • Gaviscon

H2 Receptor Blockers

H2 receptor blockers reduce the production of stomach acids, which can minimize reflux. H2 blockers available over the counter include such popular brands as:

  • Pepcid (famotidine)
  • Tagamet (cimetidine)
  • Zantac 360 (famotidine)

Side effects include constipation, diarrhea, dry mouth, headaches, and ringing in the ears (tinnitus).

In 2020, the Food and Drug Administration (FDA) issued a recall of all medications containing the ingredient ranitidine, including Zantac. In 2021, the manufacturer released a new version of the drug, called Zantac 360, with a new active ingredient: famotidine.

Proton Pump Inhibitors

Proton pump inhibitors offer similar action to H2 blockers but are stronger and faster. They include Nexium (esomeprazole), Prevacid (lansoprazole), Pantoprazole (protonix), and Prilosec (omeprazole). PPIs are more typically used if an H2 blocker fails to provide relief.

Common side effects are similar to those of H2 receptor blockers and include headache, constipation, diarrhea, and flatulence.

Prescriptions

If OTC medications aren't effective in relieving your heartburn symptoms, you may need a stronger version. Your healthcare provider will determine whether a prescription-strength H2 blocker or PPI is an option for you.

In addition to stronger versions of OTC medications, your healthcare provider may also consider a PPI medication available only by prescription, such as:

  • Protonix (pantoprazole)
  • Aciphex (rabeprazole)
  • Dexilant (dexlansoprazole)

Surgeries

Surgery for a hiatal hernia is indicated if it has turned into a paraesophageal hernia and is causing symptoms that cannot be treated with medications or lifestyle changes. A paraesophageal hernia occurs when a hiatal hernia worsens and larger portions of the stomach begin to enter the chest cavity.

Surgery is also considered for sliding hernias if it's associated with GERD. In this type of hernia, the stomach intermittently slides up into the chest through a small opening in the diaphragm.

A paraesophageal hernia has an increased risk of serious complications. These include volvulus (a condition where the stomach twists more than 180 degrees) and strangulation (where blood circulation is cut off). Both are considered medical emergencies.

Paraesophageal hernias tend to be progressive, so it's best to treat them sooner rather than later.

If you have a large hernia, the type of surgery needed to repair it will be determined by the nature and severity of the complication.

Open or Laparoscopic Repair

Either a transthoracic ("open") or transabdominal (laparoscopic, or "keyhole") surgery may be used to repair a paraesophageal hernia.

  • Open surgery involves entry into the body through an incision, usually on the left side of the body. It is more commonly used in emergency situations where there is severe bleeding or an organ rupture. It may also be used in non-emergency situations, such as when the entire stomach has slipped into the chest cavity (known as an intrathoracic stomach).
  • Laparoscopic surgery involves the insertion of multiple surgical instruments into three keyhole-sized incisions in the abdomen. For non-emergency situations, it is considered just as effective as a transthoracic surgery but with far fewer complications and quicker recovery time.

Nissen Fundoplication

Nissen fundoplication is performed laparoscopically. The aim of the surgery is to tightly wrap the upper part of the stomach (called the fundus) around the esophagus and secure it in place with stitches or staples so that it's held upright and supported.

If performed correctly, fundoplication can realign the LES into a position where it functions normally. Partial fundoplication, like a Toupet procedure, is an option. So is the transoral incisionless fundoplication (TIF), which is performed according to the same principles as a laparoscopic procedure.

Nissen fundoplication is considered safe and effective. It has less than 1% risk of mortality and an efficacy rate of 89.5% over 10 years.

Bloating, vomiting, burping, and difficulty swallowing are common postoperative side effects that tend to resolve on their own within two to four weeks.

How effective is hiatal hernia surgery?

Researchers estimate that about 50% of patients undergoing laparoscopic repair experience small anatomic recurrences at long-term follow-up.

Hiatal Hernia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

Complementary and Alternative Medicine (CAM)

In addition to antacids and acid blockers, some complementary therapies may provide some relief from acute reflux symptoms.

Licorice

Licorice, derived from the licorice root, has long been used to treat heartburn and other gastrointestinal symptoms. While research remains lacking, some studies have suggested that it has its place alongside traditional acid-blocking medications.

A 2013 study showed that the combined use of a licorice root extract and a prescription-strength PPI (pantoprazole) resulted in fewer symptoms of heartburn, chest pain, and abdominal swelling compared to using a PPI alone.

Licorice tea is one of the more common forms used. Another, known as deglycyrrhizinated licorice (DGL), is available as a nutritional supplement and may be more tolerable due to the removal of glycyrrhizin (a substance known to lower blood potassium levels).

Ginger

Ginger is another popular option that may help alleviate heartburn symptoms. Ginger root is rich in antioxidants and contains compounds believed to reduce gastric contractions and, thus, lessen the likelihood of acid reflux.

However, if used in excess, ginger may have the opposite effect.

A 2014 study from Stanford University reported that, while ginger extract or powder form may relieve spasms and improve gastrointestinal motility, daily doses of higher than 5 grams could actually increase the risk of heartburn and abdominal discomfort.

Ginger can be purchased as a tea or in powder, capsule, or liquid formulations.

As with any CAM options, it's best to discuss licorice and ginger with your healthcare provider before trying them.

Preparing for Your Appointment

Your initial appointment is usually with a general practitioner, such as an internist or family practitioner. If surgery is needed to repair your hernia, you will likely be referred to a gastroenterologist—a doctor who specializes in digestive conditions.

How You Can Prepare

  • Write down any symptoms you're experiencing.
  • Bring a list of all your medications, vitamins, and supplements.
  • Make a list of your health conditions, including any recent changes or stressors in your life.
  • Write down questions you want to ask.
  • Ask a relative or friend to come with you to help you remember the information provided.

What to Expect

A healthcare provider will perform a physical exam, take a health history, and ask questions about your symptoms, such as:

  • What are your specific symptoms?
  • How severe are they?
  • Are they continuous or occasional?
  • Have you noticed anything that makes your symptoms better or worse?

Questions to Ask Your Healthcare Provider

Some questions to consider asking, depending on your health history, include:

  • What caused my hiatal hernia?
  • Are there tests that need to be done and how do I need to prepare?
  • What are my treatment options?
  • What are the benefits and risks of the treatment options?
  • How should I manage my health conditions together? (if you have other health conditions)

When meeting with your healthcare provider, you may think of additional questions to ask.

Summary

A hiatal hernia is a common condition that can cause heartburn and other GERD-like symptoms. Your healthcare provider may suggest lifestyle changes, OTC antacids, or prescription medications to reduce your symptoms.

For a more severe case, known as paraesophageal hernia, surgery may be needed to prevent serious complications.

Frequently Asked Questions

  • What causes a hiatal hernia?

    A hiatal hernia is usually caused by increased pressure in the abdominal cavity. That pressure can build up from obesity, pregnancy, coughing, vomiting, straining with a bowel movement, and physical exertion.

  • When should you seek treatment for a hiatal hernia?

    Let your healthcare provider know if you're having persistent symptoms, whether your symptoms get worse, or if they return despite treatment. If you're experiencing chest pain, which can also be a symptom of a heart attack, seek emergency care.

  • How long does hiatal hernia surgery take?

    Both laparoscopic and open repair surgeries can take two to three hours.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sharon Gillson
 Sharon Gillson is a writer living with and covering GERD and other digestive issues.