Hiatus hernia

Many patients with heartburn also have a hiatus hernia (also known as hiatal hernia), which is when the stomach rides up into the chest, through an expanded space in the diaphragm, usually just occupied by the oesophagus.

Hiatus hernia is one of the important factors that contribute to the development of heartburn, gastro-oesophageal reflux and volume reflux (where a significant volume of stomach fluid passes back up the oesophagus). When the volume reflux is severe patients can present with night-time coughing/choking, recurrent chest infections, a chronic hoarse voice and poor dentition. When there is anatomic disruption of the hiatus, as in hiatus hernia, it is best to consider a surgical solution, as it can restore the anatomy and normal function. When a hiatus hernia is very large it can also produce symptoms of chest pain, shortness of breath and difficulties in swallowing.

Laparoscopic anti-reflux surgery is now very effective in curing heartburn and gastro-oesophageal reflux by restoring the stomach to it's proper position and recreating the valve effect. There are various surgical options available and the decision as to the most appropriate one for you will depend on the result of a number of preoperative tests, possibly including endoscopy, barium swallow, pH testing and manometry. These will be discussed with you so that you can make an informed decision.

While the majority of patients with heartburn can be managed with various antacid medication, it is important that patients are considered for a surgical solution, when this is appropriate.

For further information, see the video on Hiatus hernia explaining the medical condition.