A hiatal hernia occurs when a portion of the stomach protrudes upward through an opening in the diaphragm, the muscular wall separating the chest from the abdomen. This condition is common, especially among those over 50. While some people have no noticeable symptoms, others experience issues such as heartburn, acid reflux, or difficulty swallowing.
Your First Stop: Primary Care Physician
A primary care physician (PCP) is typically the first stop when symptoms suggestive of a hiatal hernia arise. The PCP conducts an initial assessment, reviewing symptoms like heartburn, chest pain, or difficulty swallowing. They also consider a patient’s medical history and perform a physical examination to help rule out other conditions with similar symptoms.
A PCP offers initial guidance, often including recommendations for lifestyle modifications such as dietary adjustments or elevating the head during sleep. They may suggest over-the-counter medications to manage acid reflux symptoms. If symptoms persist or suggest a more complex issue, the PCP facilitates a referral to a specialist for further investigation and management.
When to See a Specialist: The Gastroenterologist
A gastroenterologist is the primary specialist for diagnosing and medically managing hiatal hernias, possessing expertise in disorders affecting the digestive system. These specialists employ various diagnostic procedures to confirm a hiatal hernia and assess its extent. Common tests include an upper GI endoscopy, where a flexible tube with a camera is inserted to visualize the esophagus and stomach, and a barium swallow, which uses a chalky liquid and X-rays to outline the digestive tract.
Upon diagnosis, the gastroenterologist oversees non-surgical treatment options aimed at alleviating symptoms. This often involves prescribing medications like antacids, H-2 receptor blockers, or proton pump inhibitors (PPIs) to reduce stomach acid production and allow the esophagus to heal. They also provide advice on dietary changes and other lifestyle adjustments that can reduce discomfort.
Considering Surgery: The Role of a Surgeon
Surgical intervention for a hiatal hernia is considered when severe symptoms do not respond to medical treatment and lifestyle changes, or when complications arise. Such complications can include persistent acid reflux damaging the esophagus, or in rare cases, strangulation where the blood supply to the herniated tissue is compromised.
A general surgeon, or sometimes a thoracic surgeon, performs these procedures. The goals of hiatal hernia surgery are to reposition the stomach back into the abdominal cavity and to narrow the enlarged opening in the diaphragm. This often involves stitching the diaphragm to reduce the size of the hiatus and may include procedures like fundoplication, where part of the stomach is wrapped around the lower esophagus to reinforce the anti-reflux barrier. Many repairs are performed using minimally invasive laparoscopic techniques, which lead to faster recovery times.