Hiatal Hernia
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Hiatal Hernia

What is a hiatal hernia?

A hernia is when part of an organ goes through an opening in the muscle wall around it.

In a hiatal hernia, part of your stomach pushes up into an opening (the hiatus) in your diaphragm. The diaphragm is the muscle between your stomach and your chest.

In most cases, your food pipe (esophagus) goes through the hiatus and joins your stomach. But with a hiatal hernia, the top part of your stomach moves up through that opening into your chest.

The top part of your stomach gets pinched. Stomach acid can back up (reflux) through the opening. This may cause heartburn and other symptoms.

There are 2 types of hiatal hernias: sliding and paraesophageal.

Sliding hiatal hernia

  • Is most common
  • Happens when part of the stomach, and the place where the stomach and esophagus meet, slide up into your chest through the opening (hiatus)

Paraesophageal hernia

  • Is less common but can be more serious
  • Happens when part of your stomach pushes up through the opening (hiatus) into your chest and is next to your esophagus

What causes a hiatal hernia?

Experts don’t know what causes hiatal hernias. Some causes may include:

  • Coughing
  • Vomiting
  • Straining while having a bowel movement
  • Sudden physical effort
  • Pregnancy
  • Obesity

Who is at risk for a hiatal hernia?

You may be at greater risk for a hiatal hernia if you:

  • Are over 50 years old
  • Are overweight or obese
  • Are pregnant
  • Smoke

What are the symptoms of a hiatal hernia?

In many cases a hiatal hernia has no symptoms.

Some people do have symptoms. These may include:

  • Burping
  • Feeling nauseous
  • Vomiting
  • Backflow (reflux) of acid or stomach contents into the esophagus or throat

Paraesophageal hernias may have more severe symptoms. These can include:

  • Having trouble swallowing sometimes, most often with solid foods
  • Feeling full after eating only a small amount of food
  • Belly (abdominal) or chest pain
  • Abdominal bleeding
  • Blood loss (anemia)

In some cases a paraesophageal hernia can lead to a medical emergency. The stomach or abdominal organs may turn or twist, causing very bad pain. There is a danger that the stomach’s blood supply may be cut off (strangulation). This is an emergency. You will likely need surgery right away.

The symptoms of a hiatal hernia may look like other health problems. Always see your health care provider to be sure.

How is a hiatal hernia diagnosed?

Your health care provider will give you a physical exam. He or she will look at your past health.

You may also have tests including:

  • Chest X-ray. This may show that you have a hiatal hernia.
  • Upper endoscopy, also called EGD (esophagogastroduodenoscopy). This test looks at the lining of your food pipe (esophagus), stomach, and the first part of your small intestine (the duodenum). It uses a thin lighted tube, called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your health care provider can see the inside of these organs.
  • Upper GI (gastrointestinal) series or barium swallow. This test looks at the organs of the top part of your digestive system. It checks your food pipe (esophagus), stomach, and the first part of your small intestine (the duodenum). You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. 
  • Esophageal manometry. This test checks the strength of your esophagus muscles. It can see if you have any problems with reflux or swallowing. A small tube is put into your nostril, then down your throat into your esophagus. This measures the pressure that your esophagus muscles make at rest.

How is a hiatal hernia treated?

Your health care provider will create a care plan for you based on:

  • Your age, overall health, and past health
  • How serious your case is
  • How well you handle some medicines, treatments, or therapies
  • If your condition is expected to get worse
  • What you would like to do

In most cases you won’t need treatment. But you may need medical care if your hernia:

  • Is at risk of being twisted so much that blood supply is cut off to your stomach (strangulation)
  • Is more difficult because of severe GERD (gastroesophageal reflux disease)
  • Is more difficult because of redness and swelling (inflammation) of your esophagus (esophagitis)

Your health care provider may suggest medicines to:

  • Weaken or neutralize stomach acid (antacids)
  • Reduce the amount of acid your stomach makes (H-2 blockers or proton pump inhibitors)
  • Strengthen your LES or lower esophageal sphincter. The LES is the muscle that stops stomach acid from backing up into your esophagus.

In severe cases surgery may also be needed to:

  • Make your hernia smaller
  • Stop loss of blood flow to your stomach (strangulation) by closing the opening in your diaphragm

What are the complications of a hiatal hernia?

In most cases a hiatal hernia won’t lead to other health problems.

In some cases it can cause other problems such as:

  • Severe GERD (gastroesophageal reflux disease)
  • Lung problems or pneumonia because stomach contents have moved up into your esophagus and into 1 or both lungs
  • Strangulation of the hernia, cutting off blood flow to your stomach. This is a medical emergency.

What can I do to prevent a hiatal hernia?

Health experts don’t know what causes hiatal hernias. They don’t know how to stop them from happening.

Living with a hiatal hernia

Follow your health care provider’s advice for treating and managing your hiatal hernia. You may need to make some lifestyle changes, such as:

  • Losing weight if you are overweight or obese
  • Not eating for 3 to 4 hours before going to bed
  • Not bending over right after eating
  • Quitting smoking

When should I call my health care provider?

Call your health care provider if your symptoms come back after treatment has stopped them. Let him or her know if symptoms get worse or you have new symptoms.

Key points about hiatal hernias

  • A hiatal hernia is when part of your stomach pushes up into an opening (the hiatus) in your diaphragm.
  • There are 2 types of hiatal hernias: sliding and paraesophageal.
  • Paraesophageal hernias are less common but can be more serious. You may need surgery.
  • Experts don’t know what causes hiatal hernias.
  • In most cases there are no symptoms.
  • In most cases no medical care is needed.

Next steps

Tips to help you get the most from a visit to your health care provider:
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: Weisbart, Ed, M.D.
Online Medical Reviewer: Ziegler, Olivia Walton, MS, PA-C
Date Last Reviewed: 10/28/2013
© 2000-2015 The StayWell Company, LLC. 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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