Hiatal Hernia
What Is a Hiatal Hernia?
A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm and into the chest cavity. The diaphragm is the muscle that separates the chest from the abdomen and helps keep acid and food in the stomach. When the stomach moves through an opening (hiatus) in the diaphragm, it can contribute to symptoms such as heartburn, regurgitation, and chest discomfort.
Hiatal hernias are common and often increase in frequency with age. Some people have a hiatal hernia without symptoms, while others experience recurrent reflux or complications that require medical or surgical treatment.
Types of Hiatal Hernia
There are two primary types:
- Sliding hiatal hernia — the most common type, where the stomach and the junction between the stomach and esophagus slide up into the chest.
- Paraesophageal (rolling) hernia — less common but potentially more serious, where part of the stomach pushes up beside the esophagus, which can lead to obstruction or strangulation.
Causes and Risk Factors
Hiatal hernias may develop due to weakening of the diaphragm with age, increased pressure in the abdomen, or structural changes. Contributing factors include:
- Aging and weakened diaphragmatic tissue
- Obesity
- Pregnancy
- Heavy lifting or straining
- Chronic coughing or constipation
Signs and Symptoms
Many people with a hiatal hernia have no symptoms. When symptoms occur, they are often related to gastroesophageal reflux and irritation of the esophagus:
- Heartburn or burning sensation in the chest
- Regurgitation of food or sour liquid
- Difficulty swallowing (dysphagia)
- Chest or upper abdominal discomfort
- Bloating or belching
Large paraesophageal hernias may cause more severe symptoms, such as chest pain, shortness of breath, or early satiety (feeling full quickly).
Diagnosis
Diagnosis of a hiatal hernia typically includes:
- Upper GI series (barium swallow) — X‑ray test that shows the movement of the stomach and esophagus
- Endoscopy — direct visualization of the esophagus and stomach lining with a camera
- Esophageal manometry — measures muscle function in the esophagus
- pH monitoring — evaluates acid reflux severity
Treatment Options
Treatment depends on symptoms and severity. Many people with a small, asymptomatic hiatal hernia require no immediate intervention and are managed conservatively. Options include:
- Lifestyle and diet modifications — avoiding trigger foods, eating smaller meals, weight management
- Medications — antacids, proton pump inhibitors, or H2 blockers to reduce acid and relieve symptoms
- Surgery — considered for recurrent reflux, large paraesophageal hernias, or complications; may involve repairing the hernia and tightening the diaphragm via fundoplication or similar procedures
Surgical approaches may be open or minimally invasive (laparoscopic), with the goal of reducing the hernia and restoring normal anatomy to prevent reflux and complications.
