Hiatal Hernia

  • Medical Author: P John Simic, MD, FAAEM
  • Medical Editor: Ron Fuerst, MD

Facts You Should Know About Hiatal Hernias

A hiatal hernia is a very common condition.
A hiatal hernia is a very common condition.

Hiatal hernia is a condition in which the upper portion of the stomach protrudes into the chest cavity through an opening of the diaphragm called the esophageal hiatus. This opening usually is only large enough to accommodate the esophagus. With weakening and enlargement however, the opening (or herniation) can allow upward passage (herniation) or even entrapment of the upper stomach above the diaphragm.

  • Hiatal hernia is a common condition. By age 60, up to 60% of people have it to some degree.
  • There are 2 types of hiatal hernia.
    • The sliding type, as its name implies, occurs when the junction between the stomach and esophagus slides up through the esophageal hiatus during moments of increased pressure in the abdominal cavity. When the pressure is relieved, the stomach falls back down with gravity to its normal position.
    • The fixed type (or paraesophageal) implies that there is no sliding up and down. A portion of the stomach remains stuck in the chest cavity.

What Causes Hiatal Hernia?

Suspected causes or contributing factors:

What Are Hiatal Hernia Symptoms and Signs?

For most people, a hiatal hernia by itself causes no symptoms.

Symptoms can include:

Other causes: Rarely, with a fixed hiatal hernia, the blood supply is cut off to the trapped portion of the stomach, causing great pain and serious illness. This is called a strangulated hiatal hernia, and it is a true medical emergency.

Hiatal hernia also causes symptoms of discomfort when it is associated with a condition called gastroesophageal reflux disease, commonly called GERD. This condition is characterized by regurgitation of stomach acids and digestive enzymes into the esophagus through a weakened sphincter that is supposed to act as a one-way valve between the esophagus and stomach. Hiatal hernia is thought to contribute to the weakening of this sphincter muscle.

Although it is true that hiatal hernia or GERD can cause chest pain similar to angina (or heart pain) including chest pressure that can radiate to the arm or neck, do not assume that such pain is caused by the less serious condition of the two. When in doubt, it is safer to be seen by a doctor immediately in order to rule out more serious problems first.

When to Seek Medical Care for Hiatal Hernia

When to call the doctor

  • When the symptoms of hiatal hernia are new, persistent (won't go away), or severe
  • When it is not clear what is causing your symptoms

When to go to the hospital

What Exams and Tests Diagnose a Hiatal Hernia?

The first visit for the symptoms of hiatal hernia may warrant tests to rule out more serious or life-threatening causes first, such as heart disease.

A thorough history will be taken to determine associated symptoms, circumstances, and risk factors for various diseases. Tell the doctor about foods or activities that help or worsen the symptoms.

A complete physical exam will focus on the digestive, pulmonary (lungs), and cardiovascular (heart) systems. A rectal exam and stool test for blood may be necessary to determine if there is bleeding from the digestive tract.

  • Initial tests
    • Electrocardiogram (ECG) to look for electrical disturbances of the heart from disease
    • Chest X-ray to look for pneumonia, collapsed lung, or other problems in the chest
    • Blood tests to look for anemia, infection, or injury to the heart, pancreas, or liver
    • Other tests focusing on the cardiovascular and pulmonary organ systems if suspicion remains high for problems in these areas
  • Possible follow-up tests
    • Barium swallow or upper GI x-ray series may be performed by a radiologist (you drinks some contrast material, and x-rays are taken).
    • Endoscopy may be performed by a gastroenterologist. A long fiberoptic scope is passed through the mouth and into the stomach looking for an ulcer, tumor, or other tissue damage. Sometimes a biopsy is needed.

Medical Treatment and Surgery for Hiatal Hernia

  • Medical treatment for hiatal hernia may include prescription-strength antacids such as lansoprazole (Prevacid), omeprazole (Prilosec), or rabeprazole (Aciphex).
  • Surgical treatments rarely are necessary except when emergency exists, such as a strangulated hiatal hernia or aggressive conservative therapy has failed.
  • Some people don't respond to home care or medical treatment and seek the advice of a general surgeon or thoracic surgeon about the latest options. Various techniques have been tried to fix the defects of hiatal hernia with some success.

Lifestyle and Diet Changes for Hiatal Hernia

Lifestyle changes are often necessary to avoid symptoms of hiatal hernia.

  • Modify your activities:
    • Minimize heavy lifting, straining, bending over.
    • Improve seated posture; don't slouch.
    • Exercise more.
    • Lose weight.
    • Sleep on an incline, with head of bed raised 4-6 inches on blocks.
    • Choose standing activities after a meal rather than sitting or reclining.
  • Try over-the-counter remedies. Check with your doctor or pharmacist first if you are taking other medications, are pregnant, or have other medical conditions, before starting therapy at home.
    • Antacids such as Mylanta, Maalox, Gaviscon, or Tums for acute symptoms
    • Antacids such as Zantac, Tagamet, Pepcid, or Axid to prevent symptoms

Hiatal Hernia Follow-up

  • Follow the treatment plan you and your doctor discuss.
  • Keep appointments for further tests or exams.
  • Start the necessary lifestyle changes.

Is It Possible to Prevent a Hiatal Hernia?

  • Lose weight, if overweight.
  • Avoid excessive straining, bending, and slouching.
  • Try the other lifestyle changes suggested under Self-Care.

What Is the Prognosis of a Hiatal Hernia?

If treated appropriately and lifestyle changes are made, you can minimize the effects of a hiatal hernia. If left untreated, complications can arise such as a strangulated hiatal hernia.

  • For hiatal hernia associated with GERD, complications can include bleeding, perforation of the esophagus, and a greatly increased risk for esophageal cancer (one of the more serious forms of cancer).

Health Solutions From Our Sponsors

"Hiatal Hernia." UpToDate.com