Acid Reflux and Hiatal Hernia: Why Symptoms Get Worse in Summer and What to Do

“A hiatal hernia is a condition in which a portion of the stomach, which may vary in size, moves upward through the esophageal hiatus in the diaphragm and into the chest due to weakening of the anatomical supporting structures. This alters the ‘valve’ mechanism of the gastroesophageal sphincter, which normally prevents stomach contents from flowing back into the esophagus, resulting in gastroesophageal reflux.

When reflux occurs, acidic gastric juices come into contact with the lining of the esophagus, causing characteristic symptoms such as heartburn, regurgitation, digestive difficulties, and belching,” explains Professor Olmi.

A hiatal hernia should therefore be considered one of the conditions that can contribute to gastroesophageal reflux, although it does not always cause symptoms.

In people with a hiatal hernia, certain typical summer habits can trigger or worsen gastroesophageal reflux, because through different mechanisms they increase the likelihood of stomach contents flowing back into the esophagus. Let’s look at them in more detail.

Larger Meals and Richer Portions

“Very large meals excessively distend the stomach, increasing pressure at the junction between the esophagus and stomach and making it easier for gastric contents to flow back into the esophagus, particularly in people with a hiatal hernia,” explains the specialist.

High-fat foods can also worsen symptoms because they slow gastric emptying and keep food in the stomach for longer.

Alcohol Consumption

People with a hiatal hernia should consume alcoholic beverages in moderation. Alcohol can reduce the tone of the lower esophageal sphincter. When combined with large meals, it can also contribute to worsening heartburn and regurgitation.

Irregular Meal Times

During the holidays, it is more common to eat at irregular times, for example by skipping lunch or having only a light snack while at the beach or out for the day. As a result, people may arrive at dinner very hungry.

“These habits can promote reflux because they often lead to eating larger meals in a short period of time, causing greater distension of the stomach.

Eating too quickly can also contribute to symptoms by increasing the amount of air swallowed and the sensation of bloating, which may facilitate regurgitation in people who are predisposed to it,” continues Professor Olmi.

Taking a Nap After Lunch

An afternoon nap is one of the small pleasures of a summer holiday. However, people with a hiatal hernia or acid reflux should wait a few hours after lunch before lying down.

“Lying down immediately after eating makes it easier for stomach contents to flow back into the esophagus because, in a horizontal position, the effect of gravity, which helps keep gastric contents in their natural position when we are upright, is reduced,” adds the specialist.

To reduce the risk of heartburn and regurgitation, it is advisable to wait at least 2 to 3 hours after a meal before lying down, whether for an afternoon nap or before going to bed at night.

In most cases, preventing or limiting symptoms associated with a hiatal hernia does not mean giving up social occasions. A few precautions can help:

• choose meals that are not excessively large;
• avoid lying down for 2 to 3 hours after eating;
• limit alcohol consumption if it worsens symptoms;
• maintain reasonably regular meal times;
• continue treatment prescribed by your doctor without stopping it on your own;
• if reflux occurs mainly at night, continue to sleep with your upper body slightly elevated, even while on holiday. If you normally use a particular pillow or an inclined support, it may be useful to take it with you when travelling.

An occasional episode of heartburn after a particularly large meal is generally not a cause for concern. However, if you have already been diagnosed with a hiatal hernia, it is advisable to consult a gastroenterologist or a surgeon specializing in abdominal surgery if your symptoms:

• occur frequently;
• interfere with sleep;
• limit daily activities;
• do not improve with the prescribed treatment.

At Policlinico San Marco in Zingonia, Italy, patients with hiatal hernia and gastroesophageal reflux can receive care at the E-Gastric Center, a multidisciplinary program dedicated to diseases of the esophagus and stomach, from diagnosis through to laparoscopic or robotic surgery when indicated.

Following a specialist consultation, the diagnostic pathway may include tests such as gastroscopy, esophageal manometry, and pH-impedance monitoring. These examinations help identify the cause of symptoms and determine the most appropriate treatment.

In most cases, treatment is based on lifestyle changes and medication. When indicated, minimally invasive laparoscopic surgery can be performed by a team experienced in the treatment of esophageal and gastric disorders.