Hiatus hernia medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

In most cases, patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause esophageal stricture which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds. If stress has been idetified as the major riskfactor, stress reduction techniques may be practiced, or if overweight, weight loss may be indicated. Certain medications causes lower esophageal sphincter (or LES to relax those medications should be avoided. Anti-acid drugs like proton pump inhibitors and H2 receptor blockers can be used to decrease the acid secretion.

Sliding hiatus hernia

Pharmacologic medical therapy is recommended among the patients with Sliding hiatus hernia when experince symptoms of gastroesophageal reflux disease (GERD) symptoms like:^[1]

• Nausea
• Vomiting
• Regurgitation
• Heart burn
• Regurgitation
• Dysphagia

• The following measures are recommended as the first line to treat GERD:^[2][3]
  • Weight loss
  • Elevating head of the bed
  • No eating two hours before going sleep
• Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
  • Coffee
  • Alcohol
  • Excessive amounts of Vitamin C supplements
  • Foods high in fats
  • Smoking
  • Eating shortly before bedtime
  • Large meals
  • Chocolate and peppermint.
  • Acidic foods, such as oranges and tomatoes.
  • Cruciferous vegetables such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
  • Milk and milk-based products
  • Medical therapy^[1][4]
    • Antacids:^[5][6]
      • Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time.
      • Preferred regimen (2): Calcium carbonate One gram PO.
    • Histamine-receptor antagonists (H2RA):^[7]
      • Preferred regimen (1): Ranitidine 150 mg q12 daily PO
      • Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
      • Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
    • Proton pump inhibitors:^[8][9]
      • Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
      • Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
    • Prokinetic medications:
      • Preferred regimen (1): Metoclopramide 10 mg q24 PO for 4 to 12 weeks

Paraesophageal hernia 

• Pharmacologic medical therapies for Paraesophageal hernia asymptomatic patients remain always  controversial.^[10]