In fact, they don't cause any problem in most people. In many patients however, acid reflux may worsen. Patients with hiatal hernia tend to have greater acid induced damage to the esophagus. The sliding of stomach in and out of abdomen may cause friction at the neck of the hernia leading to ulcers. Giant hernias may cause anemia, bleeding and chest pain.
Paraesophageal hernias are prone to strangulation.
The diagnosis is usually made as incidental finding during upper GI x ray or upper endoscopy. Patients may be prescribed acid blocking medications like Zantac, Tagamet, Axid, Pepcid, Prevacid, Prilosec, Aciphex, Protonix and Nexium etc. Surgery Need for surgery for hiatal hernia is rare. The surgeon pulls down the hernia into the abdomen and hooks it up to adjacent structures so the stomach won't escape again into the chest. Usually an anti-reflux procedure is also performed .