Hiatus hernia

A hiatus hernia is when part of your stomach moves up into your chest. It's very common if you're over 50. It doesn't normally need treatment if it's not causing you problems.

Check if you have a hiatus hernia

You can have a hiatus hernia without knowing and without it being a problem.

With a hiatus hernia you may:

• have a painful burning feeling in your chest, often after eating (heartburn)
• bring up small amounts of food or bitter-tasting fluids (acid reflux)
• have bad breath
• burp and feel bloated
• feel or be sick
• have difficulty or pain when swallowing

These are the symptoms of gastro-oesophageal reflux disease (GORD).

See a GP if:

• your symptoms don't go away after 3 weeks
• your symptoms are very bad or getting worse
• medicines from the pharmacy don't help

Get an urgent GP appointment if you have indigestion or acid reflux and:

• you've lost weight for no reason
• swallowing becomes difficult
• you're being sick (vomiting) frequently
• there's blood in your sick
• you have pain in your upper tummy

Treatment for a hiatus hernia

Broadly, treatment follows these steps:

1. Change your eating habits – for example, eat smaller, more frequent meals and do other things to help with the symptoms of GORD.
2. If you smoke, try to give up – tobacco smoke can irritate your digestive system and make your symptoms worse.
3. Buy medicines from the pharmacy – ask the pharmacist what you should take to help with the symptoms of GORD.
4. See a GP – if medicines from the pharmacy and changing your eating habits don't help, your GP can prescribe stronger medicines.
5. Further tests – if stronger medicines don't work, your GP can send you for further tests to find out if your symptoms are caused by a hiatus hernia. They might also prescribe medicines for long-term GORD.
6. Surgery – your GP might refer you to a specialist to check if you need surgery. This usually only happens if other treatments haven't worked and you keep having very bad symptoms.

Surgery for a hiatus hernia

Keyhole surgery is usually used for a hiatus hernia – this involves making small cuts in your tummy (abdomen). It's done under general anaesthetic, so you'll be asleep during the operation.

After surgery it usually takes:

• 2 to 3 days to go home
• 3 to 6 weeks to go back to work
• 6 weeks before you can eat what you want
• a few months to recover from side effects like bloating, burping, farting and difficulty swallowing

There's a small risk (about 1 in 100) that your side effects won't go away and you'll need more surgery.

What causes a hiatus hernia

It's not clear what causes a hiatus hernia. Anyone can have one, but it's more common if you're over 50, pregnant or overweight.