The list of treatments mentioned in various sources for Hiatal hernia includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.
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The primary goals of treatment are to relieve symptoms by minimizing or correcting the incompetent cardia and to manage and prevent complications. Medical therapy is used first because symptoms usually respond to it and because hiatal hernia tends to recur after surgery. Such therapy attempts to modify or reduce reflux by changing the quantity or quality of refluxed gastric contents, by strengthening the LES muscle pharmacologically, or by decreasing the amount of reflux through gravity. These measures include restricting any activity that raises intra-abdominal pressure (coughing, straining, or bending), giving antiemetics, avoiding constrictive clothing, modifying diet, giving stool softeners or laxatives to prevent straining at stool, and discouraging smoking because it stimulates gastric acid production.
Modifying the diet means eating small, frequent, bland meals at least 2 hours before lying down (no bedtime snack), eating slowly, and avoiding spicy foods, fruit juices, alcoholic beverages, and coffee. Antacids also modify the fluid refluxed into the esophagus and are probably the best treatment for intermittent reflux.
To reduce the amount of reflux, the overweight patient should lose weight to decrease intra-abdominal pressure. Elevating the head of the bed 6" (15 cm) reduces gastric reflux by gravity.
Drug therapy to strengthen cardiac sphincter tone may include a cholinergic agent or a GI stimulant to enhance smooth-muscle contraction, increase cardiac sphincter tone, and decrease reflux after eating.
Surgical repair is necessary when symptoms can’t be controlled medically or with the onset of complications, such as stricture, bleeding, pulmonary aspiration, strangulation, or incarceration. Surgery typically involves creating an artificial closing mechanism at the gastroesophageal junction to strengthen the LES’s barrier function. The surgeon may use an abdominal or a thoracic approach or he may repair the hernia by laparoscopic surgery, which allows for less dependence on a nasogastric (NG) tube and a shorter hospital stay.
Source: Professional Guide to Diseases (Eighth Edition), 2005
The primary goals of treatment are to relieve symptoms by minimizing or correcting the incompetent cardia and to manage and prevent complications. Medical therapy is used initially because symptoms usually respond to it and hiatal hernia may recur after surgery.
Medical therapy attempts to modify or reduce reflux by changing the quantity or quality of refluxed gastric contents, strengthening the LES muscle pharmacologically, or decreasing the amount of reflux through gravity.
Specific measures include restricting any activity that increases intra-abdominal pressure (coughing, straining, bending), avoiding constrictive clothing, modifying diet, and discouraging smoking because it stimulates gastric acid production.
Modifying the diet means eating small, frequent meals at least 2 hours before lying down (no bedtime snacks); eating slowly; and avoiding irritating foods, alcoholic beverages, and coffee. Antacids also modify the fluid refluxed into the esophagus and are probably the best treatment for intermittent reflux.
To reduce the amount of reflux, the overweight patient should lose weight to decrease intra-abdominal pressure. Elevating the head of the bed about 6" (15 cm) reduces gastric reflux by gravity.
Drug therapy to strengthen cardiac sphincter tone may include a cholinergic agent such as bethanechol. Metoclopramide has also been used to stimulate smooth-muscle contraction, increase LES tone, and decrease reflux after eating.
Failure to control symptoms medically or the onset of such complications as stricture, bleeding, pulmonary aspiration, strangulation, or incarceration necessitates an antireflux surgical repair.
Surgery creates an artificial closing mechanism at the gastroesophageal junction to strengthen the LES’s barrier function. A transabdominal fundoplication is performed by wrapping the fundus of the stomach around the lower esophagus to prevent reflux of stomach contents. An abdominal or a thoracic approach may be used. Laparoscopic surgery to repair the hernia is now commonplace. A newer treatment involves thoroscopic surgery, with the hernia repaired microscopically.
Source: Handbook of Diseases, 2003
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