Heartburn or hiatal hernia?

Is that stomach pain and burning just heartburn (gastro-oesophageal reflux) or a hiatal hernia?

What is heartburn?

Heartburn occurs when stomach acid rises into the oesophagus and causes a burning sensation. Common symptoms include chest pain, a burning feeling, and difficulty swallowing. It is more prevalent in people who consume lots of fatty foods or tobacco, alcohol, coffee or chocolate, are pregnant, are stressed or have a connective tissue disorder.

What is a hiatal hernia?

A hiatal hernia occurs when the stomach bulges through a hole in the diaphragm. Symptoms may include heartburn, difficulty swallowing, feeling full on small amounts of food, shortness of breath and regurgitation of food into the mouth. These will only occur when the bulge is larger. The cause of these types of hernias are often unknown.

Diagnosing a hiatal hernia

If you suffer from reflux that isn’t getting better with lifestyle change, dietary changes or over-the-counter medications, it’s time to talk to your doctor. They may order tests, or send you to a surgeon to investigate. They may undertake:

• An endoscopy, to view your oesophagus and stomach.
• A barium swallow, which allows doctors to view the oesophagus and stomach with a special liquid via x-rays.
• An oesophageal manometry, which measures contractions in your oesophagus when you swallow.

What treatment options are available?

Simple heartburn on its own can be treated with antacids, which neutralise the acid in the stomach, or proton pump inhibitors, which reduce the amount of acid the stomach produces.

You may also be advised to:

• Maintain a healthy weight.
• Eat smaller meals.
• Avoid acidic, fried and fatty foods.
• Raising your head when resting, with extra pillow or other props, using gravity to help keep the stomach contents in the stomach.

Will I need surgery for my hiatal hernia?

Surgery might be considered if you are experiencing chronic reflux that isn’t getting better with other treatment or you have severe inflammation of the oesophagus, or you a large hiatus hernia.

Usually done laparoscopically, that is via multiple small incisions rather than one large open incision, a hiatal hernia can repaired like a normal hernia by pulling the oesophagus back through the diaphragm and stitching the hole closed so the stomach won’t find its way back out again. At the same time, a partial fundoplication is performed. During a fundoplication the top part of the stomach is wrapped around the lower oesophagus to create a valve that will keep the stomach acid inside the stomach.