What You Need to Know About GERD and Hiatal Hernia

GERD, or gastroesophageal reflux disease, is a persistent digestive issue where stomach acid or bile irritates the esophagus lining. This results in symptoms such as heartburn, regurgitation, & chest discomfort. This condition develops when the lower esophageal sphincter (LES), a muscle ring that typically blocks acid from returning to the esophagus, becomes weak or relaxed. 

GERD is associated with a hiatal hernia very often. Here a portion of the stomach moves upward through the diaphragm into the chest area. This hernia can further exacerbate GERD symptoms by affecting the function of the LES. Both GERD and hiatal hernia are common, affecting millions of people worldwide. 

While they can cause discomfort, with proper diagnosis and management—including lifestyle changes, medication, and, in some cases, surgery—the symptoms can be controlled, and further complications can be prevented.

The Link Between GERD and Hiatal Hernia

GERD and hiatal hernia often go hand in hand, with one condition frequently contributing to the other. While they are distinct issues, the presence of a hiatal hernia can significantly worsen GERD symptoms and vice versa. Here’s how they are connected:

• Hiatal Hernia Weakens the Lower Esophageal Sphincter (LES)
• The LES is a valve-like muscle that usually prevents stomach acid from flowing back in the esophagus. When a hiatal hernia occurs, part of the stomach moves into the chest cavity, causing the LES to malfunction. This allows stomach acid and food to flow back into the esophagus, leading to the signs and symptoms of GERD.
• Increased Pressure on the Stomach
• A hiatal hernia can also increase pressure within the stomach, which may push acid upward into the esophagus more easily. This added pressure can make GERD symptoms, such as heartburn and acid regurgitation, more frequent and severe.
• Worsened Symptoms
• People with both GERD and a hiatal hernia may experience intensified discomfort, including heartburn, chest pain, and difficulty swallowing. The hernia can make it harder for the LES to stay closed, leading to more frequent acid reflux episodes and prolonged irritation of the esophagus.
• Treatment Overlap
• Treating GERD and hiatal hernia often involves similar approaches, such as lifestyle modifications (diet changes, weight management, avoiding late-night eating), medications (antacids, proton pump inhibitors), and sometimes surgery. For patients with both conditions, treating the hiatal hernia may help reduce GERD symptoms, while controlling acid reflux can alleviate the impact of the hernia.

Diagnosing GERD and Hiatal Hernia

• Medical History and Symptom Review
• The first step in diagnosis involves discussing your symptoms with a doctor. They will ask about the frequency & intensity of symptoms like heartburn, chest pain, regurgitation, and difficulty swallowing. If you have a history of acid reflux or if lifestyle factors like diet, obesity, or smoking are contributing, this information can help guide further tests.
• Physical Exam
• While a physical exam alone cannot confirm GERD or a hiatal hernia, your doctor may check for signs of complications, such as difficulty swallowing or tenderness in the abdomen. This may help identify the severity of the condition.
• Upper Endoscopy (EGD)
• An upper endoscopy is often used to diagnose GERD and examine the esophagus, stomach, and duodenum. A flexible & thin tube with a camera in it (endoscope) is passed through the mouth to look for inflammation, ulcers, or other damage caused by acid reflux. In cases of GERD, it can also help identify a hiatal hernia.
• Barium Swallow X-ray
• In some cases, a barium swallow may be recommended. You’ll swallow a liquid that contains barium, which helps highlight the outline of your esophagus and stomach on an X-ray. This test can show if the stomach has pushed through the diaphragm, indicating a hiatal hernia, or if the esophagus is narrowing, which could suggest GERD.
• Esophageal Manometry
• This time, a thin tube is inserted through the nose into the esophagus, which records how well the LES works to prevent acid reflux. This test is instrumental when a doctor suspects abnormal esophageal function, which can be a factor in GERD and hiatal hernia.
• pH Monitoring
• To diagnose GERD precisely, pH monitoring involves inserting a tiny probe into the esophagus to measure the amount of acid refluxing into the esophagus over 24-48 hours. This test is instrumental in cases where symptoms don’t clearly match GERD but are still suggestive of acid reflux.
• Manometry and pH Monitoring Combined with Impedance Testing
• In complex cases where GERD symptoms don’t respond to treatment, impedance testing combined with manometry and pH monitoring may be used. This technique can evaluate both acid and non-acid reflux and provide a more comprehensive picture of esophageal function.

Treatment for GERD and Hiatal Hernia

• Lifestyle Modifications
• Dietary Changes: Avoid trigger foods like spicy foods, caffeine, chocolate, alcohol, and fatty meals, which can relax the lower esophageal sphincter (LES) & worsen reflux symptoms. Consuming smaller, more frequent meals & avoiding large meals before bedtime can also help.
• Weight Management: Being overweight puts additional pressure on the abdomen, which can worsen both GERD and a hiatal hernia. Losing & maintaining a healthy weight through diet and exercise can significantly reduce symptoms.
• Elevating the Head While Sleeping: Sleeping with your head raised on a pillow or adjustable bed can prevent acid from flowing back in the esophagus, particularly in individuals with GERD and hiatal hernia.
• Avoiding Tight Clothing: Tight-fitting clothes, especially around the waist, can boost pressure on the stomach and worsen symptoms. Loose-fitting attire is recommended.
• Surgical Interventions
• Fundoplication: A surgical procedure called fundoplication may be recommended for people with severe GERD that does not respond to medications or lifestyle changes. This surgery involves wrapping the stomach top around the LES, which strengthens it & prevents acid reflux.
• Laparoscopic Surgery: In some cases, surgery may be performed laparoscopically (minimally invasive) to repair a hiatal hernia. This procedure can help reposition the stomach and reduce symptoms by restoring the natural barrier between the stomach and esophagus.
• Endoscopic Procedures: Less invasive options, such as endoscopic treatments, may be considered for some individuals. These techniques use a scope to insert devices that can strengthen the LES or treat the hernia.
• Managing GERD and Hiatal Hernia Together
• Treatment often involves addressing both conditions simultaneously, as the two are interrelated. For example, managing the symptoms of GERD through diet, medication, and surgery can also help improve the symptoms of a hiatal hernia. Likewise, surgically correcting a hiatal hernia may alleviate GERD symptoms by restoring normal anatomy and function.
• Alternative and Complementary Therapies
• Herbal Remedies: Some individuals relieve GERD symptoms with herbal remedies like ginger, chamomile, or slippery elm. However, it's essential to consult a doctor before trying any sort of alternative treatments to ensure they are safe and effective.
• Acid-Alkaline Balance: While research on the alkaline diet is still limited, some people with GERD find that eating more alkaline foods (like leafy greens and root vegetables) and reducing acidic foods can help manage symptoms.

When to Seek Professional Help

While many people can manage GERD and hiatal hernia with lifestyle changes and medication, it's essential to consult your doctor if symptoms tend to be severe, persistent, or worsening. Chronic GERD can lead to severe complications such as esophageal ulcers, bleeding, or narrowing, while an untreated hiatal hernia may cause more severe pain or complications. 

A tailored treatment plan that combines dietary adjustments, medications, and, when necessary, surgery can help alleviate discomfort & prevent long-term health issues associated with these conditions.

Sterling Hospital is Your Partner in Better Health Across Gujarat

At Sterling Hospital, we provide you with the utmost care and comfort throughout your journey to a healthier life. If you are looking for the best gastro surgeon in Ahmedabad, Vadodara, or Rajkot, we've got you. With considerable years of experience, we have built a team of the best gastro surgeons in these regions to provide you with premium treatment and the best results. Contact Sterling Hospital to schedule a consultation and embark on a journey towards a healthier future.