Hiatal Hernia

Some people develop a hiatal hernia after an injury to the area. Others are born with an inherent weakness or an unusually large hiatal opening. But anything that puts intense pressure on your abdomen — including persistent or severe coughing or vomiting, pregnancy, straining while going to the bathroom, increased abdominal fluid or lifting heavy objects — can contribute to a hernia.If you get more than occasional heartburn, it may be a symptom of acid reflux disease, gastroesophageal reflux disease (GERD), an inflamed stomach lining (gastritis), hiatal hernia or peptic ulcer.

Self-care: A variety of lifestyle changes can help ease the gastroesophageal reflux that may accompany a hiatal hernia. Some or all of the following measures may help:

Eat small meals. Large meals can distend your stomach, pushing it into your chest.

Avoid problem foods and alcohol.

Try to avoid alcohol, caffeinated drinks, chocolate, onions, spicy foods, spearmint and peppermint — all of which increase production of stomach acid and relax the lower esophageal sphincter.

Even decaffeinated coffee can be irritating to an inflamed esophageal lining. Also try to limit citrus fruits and tomato-based foods. They're acidic and can irritate an inflamed esophagus.Limit fatty foods.

Fatty foods relax the lower esophageal sphincter and slow stomach emptying, which increases the amount of time that acid can back up into your esophagus.

Sit up after you eat. Wait at least three hours before going to bed or taking a nap. By then, most of the food in your stomach will have emptied into your small intestine, so it can't flow back into your esophagus.

Eating a bedtime snack stimulates acid formation and further aggravates acid reflux.Don't exercise immediately after eating.

Try to wait at least two to three hours before you engage in any strenuous activity. Low-key exercise, such as walking, is fine.

Lose weight. If you're overweight, slimming down helps reduce the pressure on your stomach. This may well be the most important thing you can do to relieve your symptoms.

Try to stop smoking. Smoking increases acid reflux and dries your saliva. Saliva helps protect your esophagus from stomach acid.

Avoid certain medications, if possible. Medications to avoid include calcium channel blockers; the antibiotic tetracycline; nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen and naproxen sodium; quinidine; theophylline; sedatives and tranquilizers; and alendronate. If you take any of these medications and have heartburn, Tylenol is much easer on the stomach.

Elevate the head of your bed. If you elevate the head of your bed six to nine inches, gravity will help prevent stomach acid from moving up into your esophagus as you sleep. Using a foam wedge to raise your mattress also may help. Don't try to use pillows, which tend to increase pressure on your abdomen.

Avoid tightfitting clothes. They put pressure on your stomach.

Take time to relax. When you're under stress, digestion slows, which makes GERD symptoms worse. Relaxation techniques such as deep breathing, meditation or yoga may help reduce acid reflux.

Foods To Avoid On The Acid Reflux Diet:

Fruit: • Orange juice• Lemon• Lemonade• Grapefruit juice• Cranberry juice• Tomato

Vegetables: • Mashed potatoes• French fries• Onion, raw

Meat: • Ground beef, chuck• Marbled sirloin• Chicken nuggets• Buffalo wings

Dairy: • Sour cream• Milk shake• Ice cream• Cottage cheese, regular

Grains: • Macaroni and cheese• Spaghetti with sauce

Beverages: • Liquor• Wine• Coffee, decaffeinated or regular• Tea, decaffeinated or regular

Fats / Oils: • Salad dressing, creamy• Salad dressing, oil & vinegar

Sweets / Desserts: • Butter cookie, high-fat• Brownie• Chocolate• Doughnut• Corn chips• Potato chips, regularSafe

Foods For The Acid Reflux DietFood Group with little potential to cause heartburn:

Fruit: • Apple, fresh• Apple, dried• Apple juice• Banana

Vegetables: • Baked potato• Broccoli• Cabbage• Carrots• Green beans• Peas

Meat: • Ground beef, extra-lean• Steak, London Broil• Chicken breast, skinless• Egg whites• Egg substitute• Fish, no added fat

Dairy: • Cheese, feta or goat• Cream cheese, fat-free• Sour cream, fat-free• Soy cheese, low-fat

Grains: • Bread, mult-grain or white• Cereal, bran or oatmeal• Corn bread• Graham crakers• Pretzels• Rice, brown or white• Rice cakes

Beverages: • Mineral water

Fats / Oils: • Salad dressing, low-fatSweets

Desserts: • Cookie, fat-free• Jelly beans• Red licorice• Potato chips, baked

Tips on preventing heartburn:Place 6- to 9-inch blocks under the legs at the head of your bed to raise it.
Try to eat at least 2 to 3 hours before lying down. If you take naps, try sleeping in a chair.

Lose weight if you're overweight.

Don't overeat.Eat high-protein, low-fat meals.Avoid tight clothes and tight belts.Avoid foods and other things that give you heartburn

Omeprazole (brand name: Prilosec) and lansoprazole (brand name: Prevacid), also reduce how much acid the stomach makes. Metoclopramide (brand name: Reglan) reduces acid reflux.

Surgical repair: A few people with a hiatal hernia may need surgery. This is usually considered only when medications and lifestyle changes fail to relieve severe reflux symptoms, or if you have complications such as chronic bleeding or narrowing or obstruction of your esophagus. Large hiatal hernias may also need repair if they cause symptoms such as shortness of breath, difficulty breathing or swallowing, or chest pain.An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removal of the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert instruments and a fiber-optic camera through several small incisions in your abdomen. The operation is then performed while your surgeon views the images on a video monitor (laparoscopic surgery).Laparoscopic surgery generally causes less pain and scarring and requires a shorter hospital stay than does thoracotomy or laparotomy. The procedure that's best for you may be determined by the kind of hernia you have and the experience of your surgeon. Patients who have laparoscopic surgery typically spend 1 to 3 days in hospital. Those who have open surgery may spent 2 to 6 days in the hospital after the procedure.During surgery, a tube was placed into the stomach through the nose and throat (nasogastric tube). Some surgeons like to leave the tube in for a few days after the procedure, while others do not.Eat small, frequent meals after the surgery and avoid gas-producing foods.Most patients go back to work in 2-3 weeks for laparoscopic surgery, or 4-6 weeks after open surgery.

Risks specific to this surgery include: Gas bloat, which causes difficulty burping or vomiting and results in bloating after meals. This occurs in about 40% of cases but gradually improves in most patients. In rare cases, the bloating is long term. Pain with swallowing (dysphagia ) occurs in 5 - 40% of patients, but improves over the first 3 months in almost all patients.Damage to the stomach or esophagus (rare)Recurrence of the hiatal hernia

Risks for any anesthesia include the following:Reactions to medicationsBreathing problems , pneumoniaHeart problemsRisks for any surgery include the following:BleedingInfection