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Hiatal Hernia

Medically reviewed by Last updated on May 2, 2022.

What is a hiatal hernia?

A hiatal hernia is a condition that causes part of your stomach to bulge through the hiatus (small opening) in your diaphragm. The part of the stomach may move up and down, or it may get trapped above the diaphragm.

Hiatal Hernia

What increases my risk for a hiatal hernia?

The exact cause of a hiatal hernia is not known. You may have been born with a large hiatus. The following may increase your risk of a hiatal hernia:

  • Obesity
  • Older age
  • Medical conditions such as diverticulosis or esophagitis
  • Previous surgery of the esophagus or stomach or trauma such as from a motor vehicle accident

What are the types of hiatal hernia?

  • Type I (sliding hiatal hernia): A portion of the stomach slides in and out of the hiatus. This type is the most common and usually causes gastroesophageal reflux disease (GERD). GERD occurs when the esophageal sphincter does not close properly and causes acid reflux. The esophageal sphincter is the lower muscle of the esophagus.
  • Type II (paraesophageal hiatal hernia): Type II hiatal hernia forms when a part of the stomach squeezes through the hiatus and lies next to the esophagus.
  • Type III (combined): Type III hiatal hernia is a combination of a sliding and a paraesophageal hiatal hernia.
  • Type IV (complex paraesophageal hiatal hernia): The whole stomach, the small and large bowels, spleen, pancreas, or liver is pushed up into the chest.

What are the signs and symptoms of a hiatal hernia?

The most common symptom is heartburn. This usually occurs after meals and spreads to your neck, jaw, or shoulder. You may have no signs or symptoms, or you may have any of the following:

  • Abdominal pain, especially in the area just above your navel
  • Bitter or acid taste in your mouth
  • Trouble swallowing
  • Coughing or hoarseness
  • Chest pain or shortness of breath that occurs after eating
  • Frequent burping or hiccups
  • Uncomfortable feeling of fullness after eating

How is a hiatal hernia diagnosed?

  • An upper GI series test includes x-rays of your esophagus, stomach, and your small intestines. It is also called a barium swallow test. You will be given barium (a chalky liquid) to drink before the pictures are taken. This liquid helps your stomach and intestines show up better on the x-rays. An upper GI series can show if you have an ulcer, a blocked intestine, or other problems.
  • An endoscopy uses a scope to see the inside of your digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures.
    Upper Endoscopy

How is a hiatal hernia treated?

Treatment depends on the type of hiatal hernia you have and on your symptoms. You may not need any treatment. You may need any of the following:

  • Medicines may be given to relieve heartburn symptoms. These medicines help to decrease or block stomach acid. You may also be given medicines that help to tighten the esophageal sphincter.
  • Surgery may be done when medicines cannot control your symptoms, or other problems are present. Your healthcare provider may also suggest surgery depending on the type of hernia you have. Your healthcare provider can put your stomach back into its normal location. He or she may make the hiatus (hole) smaller and anchor your stomach in your abdomen. Fundoplication is a surgery that wraps the upper part of the stomach around the esophageal sphincter to strengthen it.

Treatment options

The following list of medications are in some way related to or used in the treatment of this condition.

How can I manage my symptoms?

The following nutrition and lifestyle changes may be recommended to relieve symptoms of heartburn:

Prevent GERD
  • Avoid foods that make your symptoms worse. These may include spicy foods, fruit juices, alcohol, caffeine, chocolate, and mint.
  • Eat several small meals during the day. Small meals give your stomach less food to digest.
  • Avoid lying down and bending forward after you eat. Do not eat meals 2 to 3 hours before bedtime. This decreases your risk for reflux.
  • Maintain a healthy weight. If you are overweight, weight loss may help relieve your symptoms.
  • Sleep with your head elevated at least 6 inches.
  • Do not smoke. Smoking can increase your symptoms of heartburn.

Call your local emergency number (911 in the US) if:

  • You have severe chest pain and sudden trouble breathing.

When should I seek immediate care?

  • You have severe abdominal pain.
  • You try to vomit but nothing comes out (retching).
  • Your bowel movements are black or bloody.
  • Your vomit looks like coffee grounds or has blood in it.

When should I call my doctor?

  • Your symptoms are getting worse.
  • You have nausea, and you are vomiting.
  • You are losing weight without trying.
  • You have questions or concerns about your condition or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your healthcare providers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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