Diagnosis and Treatment

How is a hiatal hernia diagnosed?
A hiatal hernia can be diagnosed with a barium study, a special X-ray that allows visualization of the esophagus, or with esophagoscopy.

How are hiatal hernias treated?
Many people do not experience any symptoms of their hiatal hernia, so no treatment is necessary. However, the paraesophageal hernia (part of the stomach squeezes through the hiatus) can cause the stomach to be strangled, so surgery may be recommended if symptoms and tests suggest the need for surgical repair. Other symptoms that may occur along with the hernia, such as chest pain, should be properly evaluated. Symptoms of GERD should be treated.

When is surgery necessary?
Surgery is indicated for symptomatic hiatal hernia that is present along with these conditions:

• Gastroesophageal reflux or GERD – symptoms include heartburn, regurgitation, dysphagia (difficulty swallowing) that has not been successfully treated with medications

• Obstruction – symptoms include early satiety (filling up fast), pain with eating, nausea or vomiting, or inability to have a bowel movement Hiatal hernia surgery can sometimes be performed during laparoscopic hiatal hernia repair, which is a less invasive procedure with a faster recovery than traditional hiatal hernia surgery.

How effective is the surgery?
After the surgery, there is no guarantee that the hernia will not return, but avoiding abdominal stressors such as heavy lifting and straining, and minimizing weight gain will reduce the risk of recurrence.

When should I call the doctor?
If you have been diagnosed with a hiatal hernia, and you have the following symptoms--nausea, vomiting, unable to have a bowel movement, or pass gas--you may have a strangulated hernia or an obstruction. These are medical emergencies. Call your doctor immediately.