A hiatal hernia occurs when the upper part of your stomach bulges through the large muscle separating your abdomen and chest (diaphragm).
The diaphragm has a small opening (hiatus) through which the food tube (esophagus) passes before connecting to the stomach. In a hiatal hernia, the stomach pushes up through that opening and into the chest.
There are two main types of hiatal hernias: sliding and paraesophageal.
Ordinarily, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a sliding hiatal hernia, the stomach and the lower part of the esophagus slide up into the chest through the diaphragm. Most people with hiatal hernias have this type.
A paraesophageal hernia is more dangerous. The esophagus and stomach stay where they should be, but part of the stomach squeezes through the hiatus to sit next to the esophagus. The stomach can become squeezed and lose its blood supply, this situation is called a strangulated hernia.
Hiatal hernia – Symptoms
Most small hiatal hernias cause no signs or symptoms. But larger hiatal hernias can cause:
- Heartburn
- Backflow of food or liquid from your stomach into the mouth
- Backflow of stomach acid into the esophagus (acid reflux)
- Trouble swallowing
- Chest pain
- Feeling full soon after you eat
- Shortness of breath
- Upset stomach and vomiting
Causes
A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It’s not always clear why this happens. But a hiatal hernia might be caused by:
- Age-related changes in your diaphragm
- Injury to the area
- Being born with a larger hiatal opening than usual
- A rise in pressure in your belly, as from pregnancy, obesity, coughing, lifting something heavy, or straining on the toilet.
Risk factors
- Age 50 or older
- Obesity
more often in women
Diagnosis
A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. These tests or procedures include:
- 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.
- Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach and check for inflammation.
- Esophageal manometry. A different kind of tube goes down your throat to check the pressure in your esophagus when you swallow.
Hiatal hernia – Treatment
Most people with a hiatal hernia don’t experience any signs or symptoms and won’t need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may need medication or surgery.
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.
- Limit fried and fatty foods, alcohol, vinegar, chocolate, and caffeine.
- Eat smaller meals.
- 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.
Medications
- 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.
Surgery
Sometimes a hiatal hernia requires surgery. Surgery is generally used for people who aren’t helped by medications to relieve heartburn and acid reflux or have complications such as severe inflammation or narrowing of the esophagus.
Surgery to repair a hiatal hernia involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller or reconstructing an esophageal sphincter Nissen fundoplication. In some cases, hiatal hernia surgery is combined with weight-loss surgery, such as a sleeve gastrectomy.
Surgery may be performed using a single incision in your chest wall (thoracotomy) or using a minimally invasive technique called laparoscopy. In laparoscopic surgery, your surgeon inserts a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor.
