Doctor's Notes on Hiatal Hernia
The esophagus is a tube that connects the throat to the stomach. It passes through the chest and enters the abdomen through a hole in the diaphragm, the breathing muscle beneath the chest that separates the chest and abdomen. The term hiatal hernia describes the condition in which the upper part of the stomach that normally is located just below the diaphragm in the abdomen pushes through the esophageal opening in the diaphragm to rest within the chest cavity. This mean part of the stomach has risen up from its location in the abdomen into the chest. This is a fairly common condition, and in most cases, the cause is not known.
In most cases a hiatal hernia does not cause symptoms. If symptoms do occur, they are due to gastroesophageal reflux disease (GERD) in which the digestive fluid containing acid from the stomach moves up into the esophagus. Associated symptoms can include heartburn, belcing, nausea, and burping.
Hiatal Hernia Symptoms
For most people, a hiatal hernia by itself causes no symptoms.
Symptoms can include:
- Pain: At times, a hiatal hernia causes chest pain or upper abdominal pain when the stomach becomes trapped above the diaphragm through the narrow esophageal hiatus.
- 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.
The proper functioning of the digestive system is one of the foundations of health, but many myths surround digestive disorders. In this slideshow we separate fact from fiction about digestive diseases.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.