Hiatus hernia treatment options

Frequently asked questions

No treatment

Lifestyle changes

Antacids

Medicines to stop stomach acid being produced

An operation

What does the treatment involve?

Some people have no symptoms from a hiatus hernia. If this is the case, no treatment is needed.

Lifestyle changes which improve symptoms of hiatus hernia include:

Losing weight if overweight.

Stopping smoking.

Sleeping with the head of the bed raised.

Avoiding excess alcohol.

Avoiding tight clothing and corsets.

Avoiding eating near bedtime.

These are tablets or liquid which neutralise the acid coming from the stomach, making it less uncomfortable.

Two types of medicines are used to reduce the amount of acid the stomach makes: proton pump inhibitors - PPIs (eg, omeprazole, lansoprazole, esomeprazole) or H

₂

-receptor antagonists.

An operation tightens the valve at the top of the stomach, so that acid is prevented from passing back up into the gullet. This is usually done by wrapping a loop of the stomach around the lower part of the gullet. It can be done through a telescope (a laparoscopic approach) rather than using a large cut.

How effective is it?

Not effective for the hiatus hernia; however, if there are no symptoms this does not matter.

This may improve symptoms so that further treatments may not be needed.

These usually help temporarily; however, the effect does not last for long, so you may have to take them several times each day.

PPIs are the most effective medical treatment for symptoms of hiatus hernia and usually work very well. These medicines do not cure the hiatus hernia, but they do help the symptoms.

The operation is effective and cures the hiatus hernia as well as the symptoms. The operation is successful in 85-95 out of 100 cases, but depends on individual factors. The hernia can come back in 30-50 out of 100 successful operations, within five years, although it does depend on the type of hernia and on how big it is. In some centres up to half of operations done for hiatus hernias are repeat operations.

Who is this treatment most appropriate for?

For people with no symptoms.

For people who are overweight, or who smoke. For people who do not want to take long-term medicines.

For people with mild occasional symptoms.

For people with troublesome symptoms of hiatus hernia.

For people in whom the medicines have not worked, and who have persisting severe symptoms. For people who have troublesome symptoms and do not wish to take daily medicines for life. For people with the less common type of hiatus hernia (para-oesophageal hernia).

What are the advantages of this treatment?

No side-effects.

No side-effects. Promotes a healthy lifestyle and therefore has other advantages to health. May allow you to avoid taking medicines.

Medicines can be taken as needed rather than regularly. Antacids come in liquid form or as chewy tablets. There are very few side-effects.

These are the most effective option other than an operation. They are usually taken daily but some people can take them as needed.

This treats the problem itself (the hiatus hernia) rather than the symptoms (of acid reflux). You don’t have to take tablets every day.

What are the disadvantages of this treatment?

It is not suitable if symptoms are troublesome. Complications of acid reflux may develop if left untreated (eg, Barrett’s oesophagus).

It may not be effective on its own and medicines may still be needed.

They are not as effective as PPIs. You have to take them quite often, as the effect does not last for long.

There may be side-effects of the medication. Common side-effects of PPIs include: tummy ache, constipation, diarrhoea, excess wind, feeling sick and headache. Overall, fewer than 5 in 100 people taking PPIs get side-effects.

As with any operation, there are risks attached. Possible complications include problems with bloating and difficulty swallowing, bleeding, and problems with the anaesthetic. There is a small risk of very serious complications or even death.