Treatment for hiatal hernia varies depending on the severity and symptoms experienced. Patients experiencing no symptoms typically do not require treatment for hiatal hernias.

Patients who develop gastroesophageal reflux disease (GERD) or other conditions caused by a hiatal hernia may be treated in a variety of ways. They include:

• Lifestyle changes. Minimizing activities, such as heavy lifting, that put pressure on the abdomen can ease symptoms. Modifying diet and losing weight can also help.
  
  
• Medications. If lifestyle changes are not effective, medications may ease symptoms. They include:
  
  
• • Antacids. They are available over-the-counter and work by neutralizing stomach acid. Antacids, however, do not heal damage to the esophagus caused by stomach acid.
    
    
  • H2 blockers. Medications that reduce the acid levels in the stomach by blocking the chemical used to make acid. They are available over-the-counter and by prescription.
    
    
  • Proton pump inhibitors. Medications that reduce the amount of acid in the stomach by inhibiting its production. They are more effective than H2 blockers and can relieve symptoms in almost any patient with GERD.
    
    
• Surgery. If lifestyle changes and medications are not effective, surgery may be performed. This is particularly true if patients are experiencing severe symptoms, such as chronic bleeding or difficulty breathing. The goal of surgery may be to pull the stomach down into the abdomen or to make the hole in the diaphragm smaller. Another method (fundoplication) is performed to reconstruct a weak lower esophageal sphincter (LES) by wrapping the upper part of the stomach around the esophagus. Different types of possible surgeries include:
  
  
• • Thoracotomy. Performed by making a single incision in the chest wall.
    
    
  • Laparotomy. Performed by making a single incision in the abdomen.
    
    
  • Laparoscopic surgery. Performed by making several incisions in the abdomen and inserting an instrument with a fiber-optic camera (laparoscope). During surgery, images can be viewed on a video monitor. This type of surgery usually causes less pain and scarring and involves a shorter hospital stay.
    
    
  • Endoscopic surgery. Newest field of surgery for hiatal hernia and GERD that uses minimal or not external incisions. This type of surgery is time-consuming and it is unclear if it will become widely used.
    
    

Although development of a hiatal hernia cannot be prevented, there are a variety of ways to prevent the gastroesophageal reflux that often accompanies it. They include:

• Eat small meals. Large meals cause the stomach to grow and push it into the chest.
  
  
• Avoid certain medications. Some types of medications worsen reflux, such as calcium channel blockers (to treat high blood pressure), nonsteroidal anti-inflammatory drugs (NSAIDs), sedatives and tranquilizers. Recent research also indicates that taking a certain type of sleeping pills may increase the risk of developing nighttime heartburn. Consult a physician to determine whether another medication can be taken instead.
  
  
• Elevate the head of the bed. Raise the head of the bed 6 to 8 inches (15 to 20 centimeters). Elevating the head and shoulders over the stomach allows gravity to keep acid from refluxing.
  
  
• Do not wear tight-fitting clothes. This can put pressure on the stomach.
  
  
• Promote salivation by chewing gum or using lozenges. This helps clear acid that has entered the esophagus.
  
  
• Practice relaxation techniques. Deep breathing, meditation and yoga can reduce stress and decrease reflux.
  
  
• Lose weight. This can help reduce pressure on the stomach.
  
  
• Stop smoking. Smoking increases reflux and dries saliva. Saliva helps protect the esophagus from stomach acid.
  
  
• Avoid alcohol.

Traditionally, physicians have recommended that patients with GERD avoid certain foods and beverages, including citrus fruits, chocolate, fatty foods, spicy foods, tomato sauce, mint and carbonated and/or caffeinated beverages, which may increase acid production or relax LES muscles. Recent research questions the benefit of such dietary changes.

In addition, physicians typically recommend that patients avoid lying down for at least three hours after eating. The benefit of this has also not been well supported by recent research.