Hiatal hernia is a rise of a portion of the stomach (cardia) through the thorax, through the hiatal orifice. Rarely symptomatic, hernia can cause digestive discomfort, such as gastroesophageal reflux. The diet can then be modified to improve digestive comfort. In fact, it is recommended to avoid foods likely to increase the work of the stomach, those which irritate the walls of the digestive tract and finally to limit muscle-relaxing foods. In addition to these evictions, some good habits can also be put in place.
This article was updated on 04/12/2023Types of hernia and their consequences
Hiatal hernia is a portion of the stomach (upper stomach area) outside the abdomen, at the level of the thorax. The stomach rises through the hiatal opening which normally allows passage to the esophagus. This pathology is a common digestive lesion. The causes of hernia are threefold: too much laxity of the ligaments of the diaphragm, trauma or a congenital malformation. Loosening of the diaphragm is the main cause of hernia. It is favored by age, overweight and obesity.
There are four types of hernia:
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Sliding hernia (the most common): it consists of a slippage of the cardia (area located between the esophagus and the stomach). This type of hernia is often associated with gastroesophageal reflux disease (GERD).
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Rolling hernia (rare): a portion of the stomach enters the esophageal opening of the diaphragm. There is no GERD associated with this type of hernia, however strangulation of the stomach is possible.
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Mixed hernia (very rare): a combination of sliding and rolling hernias.
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The giant hernia (extremely rare): several organs move up into the thorax (generally stomach, colon, spleen and small intestine), it is a real eventration of the diaphragm.
Whatever the type of hernia, the treatment remains the same: a surgical procedure which consists of reintegrating the stomach into the abdominal cavity. Surgical procedure is rare, because the hernia is generally asymptomatic. Only complicated and chronic gastroesophageal reflux or a medical emergency such as hernial volvulus (strangulation of the stomach) can justify intervention. See the different hiatal hernias in pictures.
If the hernia prevents the ingestion of food, it is best to contact a health professional.
The alcohol
Alcohol irritates the intestinal walls and disrupts gastric emptying. The whole thing causes digestive discomfort. In addition, it would cause a reduction in the contraction of the esophageal sphincter, especially if it is consumed outside of meals. This relaxation is a favorable factor in the rise of the stomach.
We recommend you :
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to limit your consumption of alcoholic beverages: maximum 1 standard glass per day, and not every day.
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avoid consuming alcohol outside of meals.
Foods that are too fatty
Fat increases gastric work. Indeed, the passage of chyme (contents of the stomach) towards the duodenum is conditioned by various factors. These factors depend on the permeability of the pylorus (opening between the stomach and the duodenum) which includes the lipid concentration in the chyme. The fattier a meal, the longer gastric emptying will take. Thus, foods that are too fatty slow down gastric emptying by increasing the work of the stomach. In addition, they promote the production of hydrochloric acid in the stomach: a favorable factor for gastric reflux.
We recommend you :
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to limit the cheeses richest in fat: Beaufort, Comté, Parmesan, Ossau Iraty, Gruyere, Cheddar, etc.
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limit sauces and fried foods.
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consume a maximum of 50 g of cold meats per week: rillettes, dry sausages, pâtés, sausages, etc.
Strong spices and condiments
Spices and strong condiments are composed of molecules responsible for a sensation of heat, such as capsaicin, homodihydrocapsaicin, piperine, shogaol, allyl isothiocyanate, etc. In excess, they cause irritation of the digestive mucous membranes.
We recommend you :
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to favor sweet spices: vanilla, star anise, turmeric, nutmeg, saffron, cardamom, etc.
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reduce the consumption of strong spices: paprika, pepper, chilli, ginger, horseradish, etc.
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to limit strong condiments: mustard, hot, smoked, sour or acidic sauces, etc.
Foods with sour or vinegary tastes
In excess and on an empty stomach, acidic foods, whose pH is less than 7, can cause slight gastric burns, but especially esophageal burns. Although the stomach is adapted to acidity by the secretion of alkaline mucus. The hernia makes acid reflux more frequent and could disrupt the proper distribution of mucus on the walls of the stomach.
We recommend you :
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to limit acidic foods: citrus fruits, tomatoes (and their derivatives), blackcurrant, sorrel, kiwi, etc.
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to limit vinegared foods: vinegar, pickles and all pickled vegetables, etc.
Coffee, tea, chocolates and mint
Coffee, tea and chocolate contain methylxanthines, caffeine, theophylline and theobromine, respectively. These substances have a muscle relaxant power and reduce the pressure of the esophageal sphincter. This drop in pressure would increase the risk of gastric reflux. Concerning mint, it seems that excessive consumption also lowers the pressure of the esophageal sphincter.
Note that white chocolate is not affected by these comments since it does not contain cocoa. This therefore concerns dark chocolate, milk chocolate and their derived products (ganaches, confectionery, ice cream, cakes, pastries, pastries, etc.)
We recommend you :
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limit drinks based on tea, coffee or chocolate: 2 cups per day maximum.
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to limit foods containing chocolate: 10 squares of chocolate dark or milk maximum per week (approximately 50 g).
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to prefer the consumption of herbal teas. There mauve, there marshmallow or the licorice are recommended in cases of gastric disorders.
Fizzy drinks
Carbonated drinks promote gastroesophageal reflux by increasing the volume of the stomach. However, carbonated bicarbonated drinks are essential in cases of gastroesophageal reflux. We are talking about buffer drinks: they reduce acidity by providing bicarbonate (HCO3-). A property that helps many patients with sour stomach and acid reflux.
We recommend you :
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to degass bicarbonated carbonated drinks. The drinks richest in bicarbonates are: Saint-Yorre®, Vichy Célestins® and Arvie®.
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avoid bubble alcohol and sodas.
Additional advice
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Avoid overly large meals: meals that are too large promote gastroesophageal reflux. It is best to divide your diet into several small meals during the day.
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Move meals away from bedtime: we advise you to eat 2 to 3 hours before bedtime to avoid digestive reflux. At bedtime, elevate your head 30° to prevent gastric contents from rising and the discomfort that follows.
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Avoid drinking while eating and favor small, regular sips.
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Avoid clothing that is too tight at the waist.
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Improve stress management : stress leads to increased secretion of acid in the stomach (Hcl). Because of the hernia, excess acid can back up into the esophagus, causing burning. Additionally, stress slows gastric emptying by stimulating splanchnic nerve activity. The activity of the latter reduces intestinal motility. It is therefore important to use different techniques to manage your anxiety: meditation, sophrology, yoga, physical activity, reading, etc..
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Reduce tobacco and chewing gum consumption : they cause the ingestion of air, which increases gastric volume.
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Bibliography
Publication: Allemann, P., Guarnero, V., Schoepfer, A., Demartines, N., Schäfer, M. (2017), Hiatal hernia: diagnostic and therapeutic management in 2017, Rev Med Suisse, 3, no. 567, 1248-1252. https://doi.org/10.53738/REVMED.2017.13.567.1248
Work : Auvinet, EA, Hirschauer, CH, & Meunier, ALM (nd). Food, nutrition and diets (French Edition). STUDYRAMA.
Website : Kahrilas, P.J. (2006). Hiatus hernia: GI Motility online. Nature. https://www.nature.com/gimo/contents/pt1/full/gimo48.html
Website : Diet for people suffering from GERD. (2020). Gastrointestinal Society. https://badgut.org/centre-information/sante-et-nutrition/diete-pour-personnel-souffrant-de-rgo/?lang=fr
Website : Hiatal Hernia: Presentation. (2019). Lyon Center for Digestive Surgery. https://www.chirurgien-digestif.com/hernie-hiatale-presentation
Website : Hiatal hernia | SNFGE.org - French learned medical society of hepato-gastroenterology and digestive oncology. (nd). SNFGE. https://www.snfge.org/content/hernie-hiatale-0