Hiatal Hernia

Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest.

The diaphragm is the sheet of muscle that divides the chest from the abdomen.

Controlling risk factors such as obesity may help prevent hiatal hernia.

The exact cause of hiatal hernias is unknown. The condition may be due to weakness of the supporting tissue. Your risk for the problem goes up with age, obesity, and smoking. Hiatal hernias are very common. The problem occurs often in people over 50 years.

This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus.

Children with this condition are most often born with it. It often occurs with gastroesophageal reflux in infants.

Symptoms may include:
  • Chest pain
  • Heartburn that is worse when bending over or lying down
  • Swallowing difficulty

A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are due to the upward flow of stomach acid, air, or bile.

Tests that may be used include:
  • Barium swallow x-ray
  • Esophagogastroduodenoscopy (EGD)

The goals of treatment are to relieve symptoms and prevent complications.

Treatments may include:
  • Medicines to control stomach acid
  • Medicine to strengthen the muscles in the lower esophagus that keeps stomach contents from backing up
  • Surgery to repair the hiatal hernia
Other measures to reduce symptoms include:
  • Avoiding large or heavy meals
  • Not lying down or bending over right after a meal
  • Reducing weight and not smoking
  • Raising the head of the bed 4 to 6 inches

If medicines and lifestyle measures do not help control symptoms, you may need surgery.

Treatment can relieve most symptoms of hiatal hernia.

Complications may include:
  • Lung aspiration
  • Slow bleeding and iron deficiency anemia (due to a large hernia)
  • Strangulation (closing off) of the hernia