Hiatal Hernia

Overview and Facts about Hiatal Hernia

A hiatal hernia occurs when part of the stomach expands or protrudes into the chest. Specifically, the upper portion of the stomach bulges through the opening of the diaphragm. Your diaphragm is a thin muscle between your chest and abdomen.

A hiatal hernia can cause acid to move or leak from your stomach and into your esophagus (this is called gastroesophageal acid reflux disease or GERD), as your diaphragm plays a role in keeping acid from moving up into your esophagus.

Symptoms and Signs of Hiatal Hernia

A hiatal hernia may not cause any symptoms, however, heartburn is a common symptom. In severe cases, such as in strangulated hiatal hernias, sudden and severe chest pain and difficulty swallowing may occur. Such cases require emergency treatment.

Other possible symptoms include:

• Anemia from possible bleeding
• Bad breath and/or problems breathing
• Chest and/or abdominal pain
• Dry cough
• Nausea and/or vomiting
• Trouble swallowing

Causes and Risk Factors of Hiatal Hernia

A hiatal hernia is common in individuals over 50 years. Individuals with birth defects that affect the diaphragm, or a weak diaphragm, are also at risk of developing a hiatal hernia. Persistent or sudden activities that increase pressure on the diaphragm can also increase the risk of a hiatal hernia.  

Other risk factors include:

• Age, a hiatal hernia risk increases with age
• Eating large or heavy meals
• Frequently bending forward or lifting heavy objects
• Pregnancy
• Straining during bowel movements
• Vomiting

Tests and Diagnosis of Hiatal Hernia

A simple chest x-ray can be used to identify large upper stomach protrusions through the diaphragm. An esophagoscopy, or visual examination of the esophagus through the mouth, may also be performed to gain a closer inspection. A barium swallow, or upper GI study, can also be used to detect signs of a hiatal hernia.

Treatment and Care for Hiatal Hernia

Most cases of a hiatal hernia do not require treatment, and less than 5% of cases require surgery. Preventing hiatal hernias is difficult, however, individuals can take steps toward prevention by avoiding some risk factors. Stool softeners and a high-fiber diet can help alleviate symptoms. Smaller and more frequent meals are also recommended to reduce heartburn.