Q I have a hiatus hernia and my doctors tell me that I need to have an operation. The only other course of action is a lifetime of Zantac. - PS, London
A The first thing you need to do is ascertain whether you do indeed have a hernia. A hernia is any rupture in the abdominal wall that appears as a lump, usually in the groin (an inguinal hernia) or, as in your case, in the chest (a hiatus hernia).
A hiatus hernia occurs when a portion of the stomach wall protrudes through an opening in the diaphragm called the 'hiatus', through which food passes via the oesophagus into the stomach.
Typical symptoms include a burning sensation, or chest pains that can be so severe that they've been mistaken for a heart attack. Pain is usually worse when the sufferer bends over or lies down.
Most hiatus hernia sufferers who experience nothing more than heartburn are usually treated with drugs such as antacids, although the problem can worsen if left untreated, and can lead to gallstones, gastritis or ulcers.
An important insight into the condition comes from Thomas Cleave, who discovered that hiatus hernia may be caused by a diet high in refined carbohydrates, as outlined in his book The Saccharine Disease (London: Butterworth, Heinemann, 1988).
The response of your doctors seems extraordinary. An operation to reverse a hiatus hernia is not to be taken lightly as it is a complex procedure, and there can be complications.
Surgeons are turning to keyhole surgery as a less-invasive procedure, but a surgeon is only as good as the number of operations he has performed. In a study of 12 patients who underwent laparoscopic hernia repair, one needed further surgery to arrest severe bleeding, while five still suffered reflux (backing-up of food from the stomach into the oesophagus) afterwards (J Laparoendosc Surg, 1996; 6: 311-7).
Another study of 30 patients revealed that eight had complications, including reflux, reduced lung air capacity and difficulty swallowing (Ann Surg, 1997; 225: 31-8).
Standard surgery doesn't fare much better. In one study of 49 patients, one died and 18 others developed complications (J Thorac Cardiovasc Surg, 1996; 112: 1340-4).
Surgery and drugs are often unnecessary ways to control the symptoms of hiatus hernia. Most patients can lead normal lives with little or no pain just by making changes to their diet and lifestyle. A diet rich in foods high in fibre can curb symptoms, and sufferers should also avoid refined carbohydrates, as Cleave has postulated.
It's best to avoid foods that can cause flatulence, such as beans, peas and cabbage, as well as onions and fried or rich fatty foods. Choose wholewheat bread and cereals over hard fibres like oats.
The hernia patient can also help himself by reducing and regulating his stomach acid by taking digestive enzymes.
Herbalists recommend goldenseal, slippery elm bark, marshmallow and liquorice, while meadowsweet (Spiraea ulmaria) has been described as a 'herbal bicarbonate of soda'.
Finally, an osteopath or chiropractor can work on any structural problems that may be exacerbating the condition.