There’s nothing like a big meal with family or friends to perk up your spirits and satisfy your stomach. For many people, however, the moments after that meal can be miserable: acid reflux, heartburn, and indigestion that can continue for hours can ruin even the best evening.

If you find yourself struck by any of these conditions, you may be one of the millions of Americans suffering from a symptomatic hiatal hernia.

Hiatal hernia occurs when a portion of the stomach pushes through the opening in the diaphragm where the esophagus and the stomach join. The most common cause is an increase in pressure in the abdominal cavity, which can come from coughing, vomiting, heavy lifting or physical strain, as well as pregnancy and obesity.

If you have a hiatal hernia, you may or may not be aware of it. It can develop in people of all ages and sexes, although it frequently affects those in middle age. The majority of healthy people over age 50 have small hiatal hernias.

While most people with hiatal hernia have no symptoms, others may experience discomfort when acid and digestive juices from the stomach seep into the esophagus. In some cases, it can produce symptoms similar to gastroesophageal reflux disease (GERD): heartburn, indigestion, bloating, a sour taste, reflux and a feeling that something is “stuck” in the esophagus or throat.

“If your physician suspects that you have a symptomatic hiatal hernia, you may be sent for an endoscopy, in which a lighted tube with a camera is inserted into the esophagus to allow the doctor to see what’s going on,” says Seth Malin, M.D., chairman of the Department of Surgery at Delaware County Memorial Hospital. “The endoscopy can also check for other conditions related to hiatal hernia, such as esophagitis (an inflammation caused by gastric juice reflux) or Barrett’s esophagus (a precursor to esophageal cancer that requires intensive treatment by a physician).”

Depending on the severity of your symptoms and the degree of herniation, your physician may try a variety of treatment methods.

“Most patients do very well with some simple lifestyle modifications,” says William Manella, M.D., chairman of the Department of Surgery at Crozer-Chester Medical Center. “These include eating smaller meals; avoiding foods that can cause symptoms (such as alcohol, caffeine, citrus-based foods, tomato-based foods, and fatty foods); sitting or standing upright after meals, rather than lying down; and eating your last meal or snack no more than two hours before bedtime. Symptoms can also be eased through weight loss, smoking cessation and the modification of certain medication regimens, such as aspirin, ibuprofen and non-steroidal anti-inflammatory drugs (NSAIDS).”

If lifestyle modifications fail to ease your symptoms, your physician may prescribe one or more medications to ease your condition.

“There are two classes of drugs used to treat acid reflux, which is what causes the symptoms for most patients with hiatal hernia,” says Immanuel Ho, M.D., chief of the division of Gastroenterology and Hepatology at Crozer-Chester Medical Center. “The first is histamine-2 blockers, like Tagamet, Zantac or Pepcid, which reduce the production of stomach acid. The second is proton pump inhibitors (PPIs), like Prevacid or Nexium, which block the secretion of acid from the stomach. Your physician can help you determine which class is best for your condition.”

For a small number of patients with severe symptoms, lifestyle modifications and medication may not be enough. These patients may be candidates for a surgical procedure called fundoplication, which is successful for about 90 percent of patients who undergo it.

“Fundoplication can be done either laparoscopically or as an open procedure,” says Allen Gabroy, M.D., chairman of the Department of Surgery at Taylor Hospital. “During the procedure, the surgeon pulls the hiatal hernia back into the abdomen and wraps the upper part of the stomach around the lower portion of the esophagus. This way, food and acid cannot reflux back into the esophagus and cause symptoms.”

However, all patients — whether they undergo surgery or just make a few changes to their diet — should remember that treatment for hiatal hernia is an ongoing process.

“Remember, the hiatal hernia is not the direct problem,” says Mark Jacobs, M.D., chief of the Section of Gastroenterology at Delaware County Memorial Hospital. “The problem lies in the symptoms — the reflux that causes heartburn, indigestion and other side effects. By working with your physician to modify your lifestyle and explore medical and surgical alternatives, you can keep reflux under control and the hiatal hernia from slowing you down.”

To find a Crozer-Keystone gastroenterologist or surgeon who’s right for you, call 1-800-CK-HEALTH (1-800-254-3258).