Doc: The basics of hiatal hernia

Keith Roach
To Your Health

Dear Dr. Roach: After an endoscopy, the doctor told me I have a hiatal hernia. He said nothing could be done for it and that I will have to live with it the rest of my life. He gave me no medicines or advice. I am anxious about this and would appreciate any info you can give me.

Anon.

Dear Anon: The swallowing tube — the esophagus — begins at the throat, travels down the chest and finally ends by attaching to the stomach. To reach the stomach, it must go through an opening in the diaphragm, the muscle that separates the chest from the abdominal cavity. That opening is the hiatus. A hiatal hernia is a bulging of part of the stomach through the hiatus and into the chest cavity. Many times, a hiatal hernia causes no symptoms and needs no treatment.

At other times, a hiatal hernia produces GERD — gastroesophageal reflux — an upward spurting of acid and digestive juices from the stomach into the esophagus. That brings on heartburn, a common problem with many treatments. People without such a hernia also develop GERD.

Here are some tips to handle heartburn: Lose weight, if need be. Don’t eat within three hours of going to bed. Elevate the head of your bed using blocks that are 6 to 8 inches tall and placed under the bedposts. This keeps stomach juices in the stomach as you sleep. Sleep on your left side for the same reason. Don’t wear constricting garments around the abdomen or too tight a belt. Take antacids as needed — Tums, Rolaids, Mylanta and Maalox. Eliminate food that gives you heartburn. Usual offenders are citrus fruits, tomatoes, onions, spicy foods, fatty and fried foods, chocolate, carbonated beverages, mints and caffeinated drinks.

If these steps don’t solve the heartburn problem, try medicines called acid blockers: Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine) and Axid (nizatidine). In low doses, all of these can be purchased without a prescription.

The next step is medicines that turn off acid production. Prilosec (omeprazole) doesn’t require a prescription. The prescription drugs are Prevacid, Nexium, Aciphex, Protonix and Dexilant.

If necessary, surgical procedures can correct hiatal hernias.

Dear Dr. Roach: I’ve been talking in my sleep for 10 years. It bothers some people. How do you get it? I also talk back to people when sleeping. Is it true that when you talk in your sleep and people ask questions about anything you’ve done, you cannot tell a lie?

S.M.

Dear S.M.: Sleep talking is a common occurrence. The sleeper is unaware of what he or she says. Sometimes the talking is pure gibberish, but other times it makes sense. It’s not a sign of a physical or mental problem. No treatment is necessary. What makes it happen isn’t clearly understood.

If people ask a sleep talker a question, most often, if not always, the talker doesn’t give any answer. Are you thinking of spy books and movies where a captured person is given a truth serum by an enemy to extract valuable information? That doesn’t happen. It never did. Everything a sleep talker says isn’t necessarily the truth.

Email questions to ToYourGoodHealth@med.cornell.edu