Hiatal Hernia

What Is a Hiatal Hernia?

A hiatal hernia is when your stomach bulges up into your chest through an opening in your diaphragm, the muscle that separates the two areas. The opening is called the hiatus, so this condition is also called a hiatus hernia.

There are two main types of hiatal hernias: sliding and paraesophageal.

Ordinarily, your esophagus (food pipe) goes through the hiatus and attaches to your stomach. In a sliding hiatal hernia, your stomach and the lower part of your esophagus slide up into your chest through the diaphragm. Most people with hiatal hernias have this type.

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A paraesophageal hernia is more dangerous. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Your stomach can become squeezed and lose its blood supply. Your doctor might call this a strangulated hernia.

Hiatal Hernia Symptoms

Many people with hiatal hernia don’t notice any symptoms. Others may have:

  • Heartburn from gastroesophageal reflux disease (GERD)
  • Chest pain
  • Bloating
  • Burping
  • Trouble swallowing
  • Bad taste in your mouth
  • An upset stomach and vomiting
  • Backflow of food or liquid from your stomach into your mouth
  • Shortness of breath

Get medical care right away if you have a hiatal hernia and:

  • Severe pain in your chest or belly
  • A persistent upset stomach
  • Vomiting
  • Can’t poop or pass gas

These could be signs of a strangulated hernia or an obstruction, which are medical emergencies.

Hiatal Hernia Causes

Doctors don’t know why most hiatal hernias happen. Causes might include:

  • Being born with a larger hiatal opening than usual
  • Injury to the area
  • Changes in your diaphragm as you age
  • A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet

Hiatal Hernia Risk Factors

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Hiatal hernias happen more often in women, people who are overweight, and people older than 50.

Hiatal Hernia Diagnosis

To diagnose a hiatal hernia, your doctor may do tests including:

  • Barium swallow. You drink a liquid that shows up on an X-ray so your doctor can get a better look at your esophagus and stomach.
  • Endoscopy. Your doctor puts a long, thin tube called an endoscope down your throat. A camera on the end shows inside your esophagus and stomach.
  • Esophageal manometry (pressure study). A different kind of tube goes down your throat to check the pressure in your esophagus when you swallow.
  • pH test. This measures the acid levels in your esophagus.

If anemia is a concern, your doctor may take a blood sample to check your red blood cell count.

Hiatal Hernia Treatment

Most people don’t notice symptoms of a hiatal hernia and don’t need treatment.

If you have acid reflux, your doctor may suggest medications to treat those symptoms, including:

  • Antacids to weaken your stomach acid
  • Proton pump inhibitors or H-2 receptor blockers to keep your stomach from making as much acid
  • Prokinetics to make your esophageal sphincter -- the muscle that keeps stomach acid from backing up into your esophagus -- stronger. They also help muscles in your esophagus work and help your stomach empty.

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Your doctor might do surgery if you have a paraesophageal hernia (when part of your stomach squeezes through the hiatus) so your stomach doesn’t become strangled. You may also need surgery if sliding hernias bleed or become large, strangulated, or inflamed.

In surgery, your doctor reinforces your hiatus and moves your stomach. Many hiatal hernia surgeries use a method called laparoscopy. Your doctor will make a few small (5 to 10 millimeter) cuts in your belly. They insert a tool called a laparoscope through these incisions, and it sends pictures to a monitor so your doctor can see inside your body. These “minimally invasive” procedures have smaller cuts, less risk of infection, less pain and scarring, and faster recovery than traditional surgeries. You can probably go back to regular activity in 2 weeks.

Hiatal Hernia Lifestyle Changes and Home Remedies

Some changes to your daily life can help with acid reflux symptoms. They include:

  • Don’t exercise or lie down for 3 or 4 hours after you eat.
  • Avoid acidic foods like orange juice, tomato sauce, and soda.
  • A diet of mashed and soft foods is recommended for up to 2-3 weeks after surgery.
  • Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine.
  • Eat smaller meals (four or five small meals each day) and eat slowly.
  • Lift the head of your bed about 6 inches.
  • Don’t wear tight belts or clothes that put pressure on your belly.
  • Lose extra pounds.
  • Don’t smoke. Smoking is an intense heartburn generator.

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