Hiatal Hernia

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What is a hiatal hernia?

Hiatal hernia is a condition in which a portion of the stomach pushes up abnormally through an opening in the diaphragm called the hiatus. The diaphragm is a sheet of muscle that separates the chest from the abdomen. The normal hiatus permits the esophagus to transfer swallowed food to the stomach. Hiatal hernia is also called a hiatus hernia.

A hiatal hernia is often not a serious condition. Most people do not have any symptoms and are unaware of the condition. Occasionally, a large hiatal hernia can be accompanied by symptoms that include heartburn, indigestion, and a burning sensation in the upper abdomen and chest. Hiatal hernia is treatable, although treatment is often unnecessary if there are no symptoms or complications.

Complications of hiatal hernia can be serious and include strangulated hiatal hernia. Hiatal hernia may also be accompanied by GERD (gastroesophageal reflux disease), which can also lead to complications, such as the development of esophageal ulcers and gastrointestinal bleeding. Seek prompt medical care if you suspect that you have a hiatal hernia. Early diagnosis and treatment can minimize discomfort and the risk of complications. Seek immediate medical care (call 911) if you, or someone you are with, vomit blood or have sudden or severe chest pain.

What are the symptoms of a hiatal hernia?

Symptoms of a hiatal hernia can vary in nature and severity between individuals. Most people with hiatal hernia have no symptoms or complications. When symptoms of hiatal hernia occur, they can be related to acid reflux (regurgitation of stomach acid into the esophagus) because some people with hiatal hernia also have a condition called GERD (gastroesophageal reflux disease).

Symptoms of a hiatal hernia can range in severity from mild to severe and include:

  • Acidic taste in the mouth
  • Difficulty swallowing
  • Epigastric pain or burning, which can run from the stomach area up to the mouth
  • Indigestion

Symptoms that might indicate a serious or life-threatening condition

In some cases, hiatal hernia can result in serious or life-threatening complications, such as strangulated hiatal hernia or esophageal ulcers. Seek immediate medical care (call 911) if you, or someone you are with, have the following symptoms:

  • Inability to have a bowel movement or pass gas

  • Sudden or severe chest pain

  • Vomiting blood

What causes a hiatal hernia?

In most cases, the cause of hiatal hernia is not known. Some cases of hiatal hernia are caused by the following conditions:

  • Coughing
  • Episodes of violent vomiting
  • Injury
  • Straining during bowel movements
  • Unusually large hole (hiatus) in the diaphragm

What are the risk factors for a hiatal hernia?

A number of factors increase the risk of developing a hiatal hernia. Not all people with risk factors will develop the condition.

Risk factors for hiatal hernia include:

  • Age older than 50 years

  • Obesity

  • Smoking

Reducing your risk of hiatal hernia

You can lower your risk of developing a hiatal hernia by:

  • Maintaining a healthy weight

  • Not smoking

How is hiatal hernia treated?

Treatment of hiatal hernia includes an individualized, multifaceted plan that minimizes the discomfort of symptoms and decreases the risk of developing complications, such as strangulated hiatal hernia. Treatment varies depending on the severity of symptoms; the type of hiatal hernia; the presence of coexisting diseases, such as gastroesophageal reflux disease (GERD); and your age and medical history.

Treatment of hiatal hernia includes:

  • Avoiding large meals and eating several small meals throughout the day

  • Elevating the head during sleep to prevent acid reflux

  • Medications including over-the-counter antacids, such as Tums, Tagamet or Pepcid

  • Not drinking alcohol, coffee, or acidic beverages to excess

  • Not eating late at night or up to two hours before bedtime

  • Not smoking

  • Participating in a regular exercise routine to lose excess weight

  • Wearing loose-fitting clothing to minimize pressure and constriction of the abdomen

For more serious cases of hiatal hernia accompanied by GERD, drug treatment may include:

  • H2 blockers, which reduce stomach acid

  • Prokinetics, which help the stomach empty faster

  • Proton pump inhibitors, which decrease the production of stomach acid

Severe cases of hiatal hernia with complications or a high risk of complications, such as strangulated hiatal hernia or obstructed hiatal hernia, require hospitalization and surgery.

What are the potential complications of hiatal hernia?

Complications of hiatal hernia can be serious and life threatening. Complications of hiatal hernia include obstructed hiatal hernia and strangulated hiatal hernia.

When hiatal hernia is accompanied by GERD (gastroesophageal reflux disease), the esophagus is exposed to the backflow of acidic stomach contents. With time, this can damage the esophagus and lead to the following conditions:

  • Esophageal bleeding

  • Esophageal ulcers

  • Esophagitis

  • Scarring of the esophagus that can result in the formation of strictures, abnormal scar tissue that narrows the esophagus and can prevent food from reaching the stomach
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jan 19
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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