29. Hiatal Hernia The presence of a hiatal hernia does not cause any symptoms. Hiatal hernia may increase acid reflux and may worsen GERD and cause esophageal ulcers. Lifestyle changes and dietary changes are very effective in the management of hiatal hernia. Avoiding caffeine, stopping smoking and avoiding alcohol use are all very important. Eating small meals, not wearing tight clothing are also effective. Going to bed with an empty stomach( not eating or drinking for at least 3 hours before bed time ) is also advocated SURGERY is very rarely recommended. Maria Nelson