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Hiatal Hernia

Medically reviewed by Last updated on Oct 1, 2023.

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 or weak hiatus. The following may increase your risk for a hiatal hernia:

  • Obesity
  • Older age
  • A medical condition such as diverticulosis or esophagitis
  • Past esophagus or stomach surgery 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 bellybutton
  • Bitter or acid taste in your mouth
  • Trouble swallowing
  • Cough or hoarseness
  • Chest pain or shortness of breath after you eat
  • Burping or hiccups that happen often
  • Feeling full quickly after you eat a small amount

How is a hiatal hernia diagnosed?

Your healthcare provider will ask about your symptoms and when they started. Tell your provider about other medical conditions you have, your eating habits, and your activities. You may also need any of the following:

  • 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
  • Esophageal manometry measures the pressure within the esophagus and stomach.
  • Esophageal pH monitoring measures how much acid is in your stomach. A small probe is placed inside the esophagus and stomach to check the pH of your stomach acid. This test also measures the amount of acid that goes into your esophagus.

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. Any of the following may be used to treat the hernia or symptoms it causes:

  • 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. A surgeon can put your stomach back into its normal location. The surgeon 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
  • Do not have food or liquid 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.
  • Do not lie down or bend 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 not at a healthy weight, weight loss may help relieve your symptoms. Your healthcare provider will tell you what a healthy weight is for you. Your provider can help you create a safe weight loss plan, if needed.
  • Sleep with your head and upper body elevated at least 6 inches. Use pillows or a foam wedge. You can also put 6-inch blocks under the head of your bed frame.
  • 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 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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