What to Know About Hiatal Hernia

Hiatal hernia is a condition in which a portion of the stomach pushes up through the diaphragm. Most people do not have any symptoms. Doctors may find the hernia during testing for another reason. Treatment is not necessary if there are no hiatal hernia symptoms or complications. Sometimes, a large hiatal hernia causes symptoms. These can include heartburn, indigestion, or a burning feeling in the upper belly or chest. These hernias are treatable with medicine or sometimes surgery.

This article explores hiatal hernias, including their symptoms and diagnosis. It also explores how doctors approach hiatal hernia treatment.

With a hiatal hernia, the stomach is able to go up through the hiatus, an opening in the diaphragm. The hiatus is a sheet of muscle that separates the chest from the abdomen. A typical hiatus lets the esophagus transfer swallowed food to the stomach. It does not allow the stomach to push up through it.

Often, a hiatal hernia is not a serious condition. In fact, less than 10% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  of people with the condition have symptoms. Doctors recommend treating hiatal hernias that cause symptoms. 

Hiatal hernia complications are rare. However, hiatal hernia may occur with gastroesophageal reflux disease (GERD). This can lead to complications such as ulcers in the esophagus and bleeding in the digestive tract. 

Seek prompt medical care if you have hiatal hernia symptoms. Early diagnosis and treatment can reduce discomfort and the risk of complications. 

Chest pain can be a symptom of hiatal hernia. However, it can also indicate a heart attack. Call 911 for chest pain that has not been previously evaluated for possible heart attack. Other serious symptoms that warrant immediate medical care include vomiting blood.

Hiatal hernia symptoms can vary in nature and severity between people. Most people have no symptoms or complications. When symptoms occur, they often relate to acid reflux into the esophagus due to GERD. Symptoms can range in severity from mild to severe and include:

• acidic taste in the mouth
• bad breath
• belching
• difficulty swallowing
• epigastric pain or burning, which can run from the stomach area up to the mouth
• heartburn or indigestion
• nausea and vomiting

There are two main types Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of hiatal hernias:

• Sliding hiatal hernia: In this type, the junction of the esophagus and stomach and some of the stomach right below this junction slide up through the diaphragm. This is the most common type of hiatal hernia. It accounts for more than 95% of cases. 
• Paraesophageal hiatal hernia (PEH): This type involves the stomach fundus. The fundus is the upper curved portion of the stomach. In PEH, part of the fundus sticks up through the diaphragm and sits beside the esophagus. The junction of the esophagus and stomach may or may not also slide through the diaphragm.

Muscle weakness or loss of flexibility in the diaphragm may play a role. A 2021 article explains Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source that some cases of hiatal hernia are the result of injury due to increased abdominal pressure. This could occur with heavy lifting or violent coughing, straining, or vomiting. It is possible for babies to be born with a hiatal hernia as well. This birth defect is called congenital diaphragmatic hernia.

A number of factors increase the chance of developing a hiatal hernia. Not all people with risk factors will develop the condition. Factors Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  linked to hiatal hernia include:

• age older than 50 years
• family history (genetic factors)
• obesity
• pregnancy and delivery
• straining due to constipation
• stress
• smoking
• chronic obstructive pulmonary disease (COPD)

Preventing a disease or condition often relies on changing risk factors that you can control. You may be able to lower your chance of developing a hiatal hernia or complications of one by:

• maintaining a moderate weight
• not smoking
• practicing stress reduction techniques
• treating conditions associated with hiatal hernia, such as COPD

If a hiatal hernia causes symptoms, it may help to avoid foods that trigger them. This means limiting or eliminating the following:

• alcohol, caffeine, and carbonated or acidic beverages
• chocolate and mint
• citrus fruit
• fatty or fried foods
• garlic and onion
• tomato sauce, ketchup, mustard, and vinegar

Ask your doctor for guidance before making significant changes to your diet.

Learn about home remedies to soothe acid reflux and heartburn.

GERD is a condition closely related to hiatal hernia. The symptoms of the two conditions overlap. In addition, it is common Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  to have both conditions. However, it is possible to have one and not the other, so they do not necessarily cause one another. Rather, it is likely that having a hiatal hernia increases the chances of having GERD.  

To diagnose your condition, your doctor will take a medical history and possibly order testing. A physical exam and feeling your abdomen is unlikely to help with the diagnosis. However, your doctor may feel for lymph nodes around your neck and listen to your heart and lungs. 

Questions your doctor may ask include:

• What symptoms are you experiencing?
• When did your symptoms start?
• Are your symptoms constant or do they come and go?
• How severe are your symptoms? Do they disrupt your daily life?
• What, if anything, seems to make your symptoms better or worse?
• What other medical conditions do you have?
• What medications do you take?

Tests and procedures for diagnosing hiatal hernia Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source  include:

• barium swallow
• CT scan
• esophageal manometry, which evaluates your esophageal muscles when you swallow
• pH testing, which evaluates acid reflux
• upper endoscopy

Hiatal hernias without symptoms often show up when doctors use these tests to diagnose other problems.

Hiatal hernia treatment aims to improve symptoms and reduce the risk of complications. Treatment depends on several factors. These include the severity of your symptoms, the type of hiatal hernia, the presence of other diseases, and your age and medical history.

Hiatal hernia treatment includes:

• avoiding large meals and instead 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
• reducing alcohol, coffee, or acidic beverages and other dietary changes
• not eating late at night or up to 2 hours before bedtime
• not smoking
• participating in a regular exercise routine to maintain a moderate weight
• wearing loose-fitting clothing to minimize pressure and constriction of the abdomen

For hiatal hernia with GERD, drug treatment may include:

• H2 blockers, which reduce stomach acid
• proton pump inhibitors (PPIs), which decrease the production of stomach acid

For people with a chance of complications from the hernia, surgery may be necessary. After pushing the stomach below the diaphragm, the surgeon will suture a mesh plug over the opening or use sutures to strengthen the area.

What to ask your doctor about hernia surgery.

Complications of hiatal hernia can be serious but are not common. They include obstructed hiatal hernia and strangulated hiatal hernia. A strangulated hernia cuts off blood supply to the stomach. It is a medical emergency.

When GERD is also present, acidic stomach contents back flow into the esophagus. With time, this can damage the esophagus and lead to the following conditions:

• Barrett’s esophagus, a condition that increases the chance of developing esophageal cancer
• chronic difficulty swallowing
• esophageal bleeding
• esophageal ulcers 
• esophagitis
• scarring of the esophagus

Here are a few commonly asked questions about hiatal hernia. The answers have been medically reviewed by Dr. Saurabh Sethi.

Many people with a hiatal hernia do not have symptoms. However, when symptoms do manifest, they are often linked to acid reflux. You may experience heartburn, indigestion, nausea, or vomiting. 

Treatment for a hiatal hernia typically involves lifestyle and diet changes, medications to treat GERD, or surgery. You should discuss any at-home treatments or exercises with your doctor first.

A hiatal hernia is rarely serious, and you may not have any symptoms at all. However, hiatal hernias can lead to a strangulated hernia or esophageal ulcers. If you are experiencing difficulty swallowing, sudden or severe abdominal or chest pain, or bloody vomiting, seek immediate medical care.

Omeprazole can help relieve the symptoms of a hiatal hernia that occur with GERD. Omeprazole is a PPI, which means that it reduces the amount of stomach acid your body produces.

A hiatal hernia is a common condition that usually does not cause symptoms. If you have one that causes discomfort or acid reflux, treatments are available. Options include medicines to manage symptoms and surgery. Complications of hiatal hernia are rare.