Hiatus Hernia/Hiatal Hernia

A hiatal hernia occurs when part of your stomach comes up through your diaphragm.

The diaphragm is the muscle that separates your chest area from your stomach area (abdomen). Your esophagus leads to your stomach through part of the diaphragm called the hiatus. If the muscle around the hiatus is weak, the top part of your stomach can press up through your diaphragm into your chest area.

You may not even know you have a hiatal hernia if it is small. But if it is large, acid from your stomach may back up into your esophagus and cause heartburn or gastroesophageal reflux disease (GERD). A large hiatal hernia may need surgery.

You Are at Risk for Hiatus Hernia/Hiatal Hernia if You:

  • Are obese
  • Are 50 or older

Doctors don't always know what causes hiatal hernias, but causes can include:

  • Pressure on the area from straining when lifting, straining during bowel movements, coughing or vomiting
  • Having a large hiatus (part of the diaphragm)
  • Having an injury in the area

Symptoms

Often, you have no symptoms with small hiatal hernias. Larger hiatal hernias can cause symptoms including:

  • Trouble swallowing
  • Heartburn
  • Belching
  • Tiredness
  • Chest pain

See your doctor if you have signs of a hiatal hernia or other symptoms that worry you. Chest pain can be a sign of a more serious condition. Seek immediate medical care if you have chest pain.

Diagnosis

Your doctor may find your hiatal hernia when checking for the cause of your heartburn or gastroespophageal reflux disease (GERD). Tests to diagnose heartburn and GERD include:

  • X-ray – You drink a chalky liquid that coats the lining of your digestive tract and then have X-rays of your upper GI system. The chalky substance makes your insides show up better on X-rays.
  • Endoscopy – Your doctor inserts an endoscope (flexible tube equipped with a light and tiny camera) down your throat to see inside your esophagus and stomach. If needed, your doctor can get tissue samples (biopsy) during endoscopy. These samples are examined in a lab to check for problems.

Treatment

Your hiatal hernia may not need treatment. If it is larger or causes symptoms, your doctor may recommend treatment including:

Medications

  • Antacids – These neutralize acid. They may make your symptoms better for the short term, but they can't fix damage that has occurred to your esophagus. Using antacids too much can cause problems like diarrhea and constipation.
  • H-2 receptor blockers – These reduce the amount of acid your body makes. They do not act as quickly as antacids but help relieve your symptoms longer.
  • Proton pump inhibitors – These block the acid your body makes, which can let your esophagus heal.

Your doctor may recommend surgery if medication doesn't help relieve your hernia symptoms. Often, surgery to treat a hiatal hernia is combined with surgery to treat gastroespophageal reflux disease (GERD).

Surgery involves:

  • Pulling the bulging part of your stomach back down into your abdomen
  • Making the diaphragm opening smaller
  • Strengthening your esophageal sphincter (muscle)

Your doctor may need to make an incision in your chest or abdomen, or make several small incisions in your abdomen (minimally invasive).

How to Prevent Hiatus Hernia/Hiatal Hernia

You may be able to control the symptoms of a hiatal hernia in these ways:

  • Maintain your healthy weight – Extra weight pushes your abdomen upward and causes acid to back up into your esophagus.
  • Eat smaller meals.
  • Avoid food and drink that cause heartburn – These can include fatty foods, fried foods, alcohol, chocolate, garlic, onions, tomato sauce and caffeine.
  • Don't smoke.
  • Remain upright after meals for at least three hours.
  • Raise the head of your bed 6 to 9 inches. You can buy wedges at medical supply stores to raise your mattress, or put blocks under your bed to raise the frame.
  • Don't wear clothes that are tight around your waist.

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