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Hiatal hernia

Definition

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.

Alternative Names

Hernia - hiatal

Causes

The exact cause of hiatal hernia is not known. 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 of age.

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

Children with this condition are most often born with it (congenital). In infants, it often occurs with gastroesophageal reflux.

Symptoms

Symptoms may include:

• Chest pain
• Heartburn, 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.

Exams and Tests

Tests that may be used include:

• Barium swallow x-ray
• Esophagogastroduodenoscopy (EGD)

Treatment

The goals of treatment are to relieve symptoms and prevent complications. Treatments may include:

• Medicines to control stomach acid
• Endoscopic therapy to repair the hiatal hernia through upper GI endoscopy
• Surgery to repair the hiatal hernia and prevent reflux

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 (10 to 15 centimeters)

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

Outlook (Prognosis)

Treatment can relieve most symptoms of hiatal hernia.

Possible Complications

Complications may include:

• Pulmonary (lung) aspiration
• Slow bleeding and iron deficiency anemia (due to a large hernia)
• Strangulation (closing off) of the hernia (very uncommon)

When to Contact a Medical Professional

Contact your health care provider if:

• You have symptoms of a hiatal hernia.
• You have a hiatal hernia and your symptoms get worse or do not improve with treatment.
• You develop new symptoms.

Prevention

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

References

Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 129.

Richter JE, Vaezi MF. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 46.

Yates RB, Oelschlager BK. Gastroesophageal reflux disease and hiatal hernia. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 43.

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