What Is a Hiatal Hernia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A hiatal hernia, or hiatus hernia, happens when the upper part of your stomach pushes up into your chest through an opening in your diaphragm called the hiatus, the muscle that separates your abdomen from your chest.

Sometimes a hiatal hernia doesn’t cause any problems at all and doesn’t require any treatment.

But in other cases, the narrow opening in your diaphragm can squeeze the part of the stomach that it surrounds, causing retention of stomach acid and other contents. These contents can back up into your esophagus, causing heartburn and other symptoms.

Types of Hiatal Hernias

There are two main types of hiatal hernias:

Sliding Hiatal Hernia This is when part of your stomach intermittently slides up into your chest through the opening in your diaphragm for your esophagus.

The vast majority of hiatal hernias are sliding, also known as type 1.

Paraesophageal Hiatal Hernia This is when part of your stomach pushes through the opening in your diaphragm next to your esophagus, so that both your esophagus and part of your stomach are squeezed together in the hiatus.

But if your hiatal hernia is causing the backflow of acid and other stomach contents in your esophagus, you may experience the following symptoms:

• Heartburn
• Acidic or sour taste in your mouth or throat

  

• Regurgitation of foods or beverages into your mouth
• Bloated feeling in your abdomen
• Frequent belching (burping)
• Chest or abdominal pain
• Difficulty swallowing
• Shortness of breath
• Vomiting blood or passing black stools (signs of gastrointestinal bleeding)

  

A hiatal hernia can also lead to gastroesophageal reflux disease (GERD), a chronic disease characterized by frequent bouts with the above symptoms.

Hiatal hernias happen because of weakening in the muscle tissue of your diaphragm, which allows your stomach to push up through the opening for your esophagus.

The specific causes of a weakened diaphragm aren’t always clear, but the following factors may play a role:

• Age-related changes to your diaphragm
• Injury from trauma or surgery
• Being born with a large hiatus (opening in the diaphragm)

  

A weakened diaphragm usually isn’t enough to cause a hiatal hernia — you also need increased pressure in your abdomen to push the stomach up through the diaphragm.

Hiatal hernias can occur at any age and affect both sexes, but certain factors increase the likelihood, including being over age 50, being overweight, smoking, and pregnancy. Increased abdominal pressure can also come from the following factors:

• Coughing
• Vomiting
• Straining during bowel movements
• Strenuous exercise
• Lifting heavy objects

  

To diagnose a hiatal hernia, your doctor will first ask you about your symptoms and perform a physical exam.

If you’re experiencing frequent heartburn or chest or abdominal pain, your doctor will probably order tests to look for the cause of your symptoms. These tests may include:

Barium Swallow After drinking a chalky liquid containing barium, you’ll undergo an X-ray which allows your doctor to see the outline of your upper digestive tract.

Esophageal Manometry This test measures muscle contractions in your esophagus when you swallow to assess its strength and muscle coordination.

pH Test A pH test measures the acid levels in your esophagus and can help determine whether your symptoms are related to acid reflux.

The duration of symptoms of a hiatal hernia vary greatly depending on the individual. In some cases, a hiatal hernia will slowly get worse over time and eventually need treatment. In severe cases, symptoms will not go away until a doctor performs surgery.

Treating a hiatal hernia can involve lifestyle changes, medication, or surgery.

Recommended lifestyle changes are generally aimed at reducing symptoms of GERD and may include losing weight, avoiding acidic, fried, or fatty foods, and quitting smoking.

Your doctor may also recommend the following medications to treat GERD:

Antacids These drugs neutralize stomach acid; over-the-counter antacids include brands like Mylanta, Rolaids, and Tums.

H2-Receptor Blockers These drugs reduce acid production and include famotidine (Pepcid), cimetidine (Tagamet), nizatidine (Axid), and (ranitidine (Zantac).

Surgery may also be needed if you have a strangulated hernia or severe GERD that isn’t responding well to lifestyle measures and medication.

To surgically repair a hiatal hernia, your doctor will pull the entire stomach back down into your abdomen and make the opening in your diaphragm smaller.

If needed, your surgeon may also repair your esophageal sphincter — the muscle that normally prevents your stomach contents from flowing back into your esophagus.

This surgery is usually done laparoscopically — involving several small incisions and using a flexible tube containing a light and camera to view the inside of your abdomen and chest.

Prevention of a Hiatal Hernia

It is difficult to prevent a hiatal hernia, but there are steps you can take to reduce your risk and minimize any symptoms. These include maintaining a healthy weight and not smoking.

If you have a hiatal hernia that leads to GERD, the following lifestyle changes can help prevent episodes of GERD:

• Losing weight
• Reducing meal and portion size
• Avoiding acidic foods, like tomatoes and citrus fruit
• Avoiding caffeine and alcohol
• Limiting carbonated beverages
• Limiting fried and fatty foods
• Eating at least three to four hours before lying down
• Keeping your head and torso elevated at least 6 inches when you rest or sleep
• Quitting smoking

  

In the majority of cases, a hiatal hernia will not lead to other health problems. However, in some instances, it can lead to GERD.

Although a hiatal hernia can cause GERD, not all people with a hiatal hernia develop GERD — and most people with GERD don’t have a hiatal hernia.

Other complications of a hiatal hernia include lung problems or pneumonia, which can occur when stomach contents move up to the lungs.

Finally, if the stomach is being squeezed so tightly that its blood supply is cut off, this is called strangulation of the hernia and emergency surgery is needed.

Still, despite how common hiatal hernias are, less than 10 percent of those affected experience significant symptoms.

If a hiatal hernia causes chest pain, it can often be confused with chest pain caused by cardiovascular conditions, including a heart attack.

In addition to chest pain, other signs of a heart attack include:

• Pain or discomfort in one or both arms, back, neck, or jaw
• Dizziness
• Nausea
• Vomiting
• Shortness of breath
• Heart palpitations
• Irregular heartbeat

Favorite Organizations for Essential Information on Hiatal Hernia

International Foundation for Gastrointestinal Disorders (IFFGD)

IFFGD is a nonprofit organization dedicated to education and research for all gastrointestinal (GI) disorders. Get essential facts on GI issues like living with a hiatal hernia and heartburn, and read personal stories from people who are dealing with the same health problems.

Cleveland Clinic

The Cleveland Clinic provides a thorough overview of what it’s like living with a hiatal hernia, as well as information on diagnostic tests and treatment.

Additional reporting by Ashley Welch.