Hiatal Hernia

Topic Overview

What is a hiatal hernia?

A hiatal hernia (say "hi-AY-tul HER-nee-uh") occurs when part of your stomach bulges upward out of your belly and into your chest cavity.

There are three main types of hiatal hernia: sliding, paraesophageal, and mixed. A sliding hiatal hernia is generally not a serious condition. Paraesophageal and mixed hiatal hernias may get worse and are more serious.

More than 9 out of 10 hiatal hernias are sliding hiatal hernias.¹ This topic focuses on sliding hiatal hernias.

What causes a hiatal hernia?

The belly (abdomen) and chest are separated by a muscle called the diaphragm. The esophagus, which is the muscular tube that connects the throat to the stomach, passes through an opening in the diaphragm called the hiatus.

A hiatal hernia is often caused by weakened muscles and connective tissue within and around the hiatus. In a sliding hiatal hernia, a small portion of the stomach pushes upward through the diaphragm at the hiatus and becomes positioned above the belly, inside the chest cavity. The valve (lower esophageal sphincter, or LES) between the esophagus and the stomach also moves up and away from the diaphragm.

See a picture of a sliding hiatal hernia .

What are the symptoms?

Most people who have a sliding hiatal hernia have no symptoms, and it often is diagnosed when a person is being evaluated for other health concerns. But when the lower esophageal sphincter slides up and away from the diaphragm, it may not close as well as it did before, and stomach acid and juices may back up into the esophagus (acid reflux). This results in an uncomfortable feeling of burning, warmth, heat, or pain behind the breastbone (sternum) that may occur after eating, soon after lying down, or when bending forward. And this feeling may come and go. You may also have a sour taste in your mouth. This group of symptoms is commonly known as heartburn or reflux.

If you have shortness of breath or pain in the area of your breastbone, you need to make sure it is not caused by a heart problem. The burning sensation caused by acid reflux usually occurs after eating. Pain from your heart is usually felt as pressure, heaviness, a weight, tightness, squeezing, discomfort, or a dull ache that occurs most often after activity. If you are not sure of the source of chest pain, call a doctor immediately.

How is a hiatal hernia diagnosed?

A hiatal hernia often is diagnosed when you are being evaluated for another health concern. A sliding hiatal hernia by itself may not have any symptoms, but it may lead to gastroesophageal reflux disease (GERD), which does cause symptoms—mainly heartburn. Often a hiatal hernia is diagnosed when you visit a doctor for symptoms of GERD.

How is it treated?

Treatment for mild symptoms begins with making lifestyle changes and, if needed, taking nonprescription antacids, acid reducers, or acid blockers. If symptoms are continual or severe, you may have GERD. Treatment for GERD usually requires prescription medications. Surgery is sometimes needed.

Frequently Asked Questions

Symptoms

A sliding hiatal hernia generally has no symptoms.

If symptoms are present, they are usually caused by acid reflux, the flow of stomach acid into the esophagus, which may be the result of a weakened lower esophageal sphincter (LES). Symptoms of reflux include:

• An uncomfortable feeling of burning, warmth, heat, or pain behind the breastbone. It may occur after eating, soon after lying down, or when bending forward. This group of symptoms is commonly known as heartburn.
• A sour or bitter taste in the mouth. The backflow of stomach acid and juices into the esophagus (known as acid reflux) may be bad enough to cause this taste in your mouth. This often occurs along with the symptoms of heartburn, but in some cases it may be your only symptom.

Other symptoms may include:

• Fullness in the upper belly after a meal.
• Difficulty swallowing (dysphagia) or a sensation of a lump in the throat (globus sensation).
• Regurgitation of stomach juices and nausea.
• A hoarse voice.

If symptoms are continual or severe, you may have gastroesophageal reflux disease (GERD), which is the abnormal backflow (reflux) of food, stomach acid, and other digestive juices into the esophagus that lasts longer and occurs more often than ordinary heartburn. Hiatal hernia and GERD often occur together. Treatment for GERD usually requires prescription medicines, and surgery may be an option. For more information, see the topic Gastroesophageal Reflux Disease (GERD).

If you have shortness of breath or pain in the area of your breastbone, you need to make sure it is not caused by a heart problem. The burning sensation caused by reflux usually occurs after eating. Pain from your heart is usually felt as pressure, heaviness, a weight, tightness, squeezing, discomfort, or a dull ache that occurs most often after activity. To learn more about chest pain that may indicate problems with your heart, see the topic Chest Pain.

Large sliding hiatal hernias may cause a complication called Cameron ulcers, which are erosions on the folds of the stomach near the opening (hiatus) in the diaphragm where the esophagus passes through. When endoscopy is used to view the hernia, Cameron ulcers are found in about 5% of people with hiatal hernias.¹ Sometimes Cameron ulcers can bleed.

Exams and Tests

A sliding hiatal hernia often is diagnosed when a person is being evaluated for another health concern. If you go to the doctor with a feeling of burning, warmth, heat, or pain behind the breastbone (often known as heartburn), your doctor will probably ask you questions about your symptoms and may want to do other tests if any of the following are true:

• You have had heartburn symptoms for a long time.
• Your symptoms do not get better with medicine.
• Your symptoms promptly come back after medicine is stopped.
• Other serious signs or symptoms are present, such as weight loss, vomiting of blood, or difficulty swallowing.

If you have symptoms and any of the above are true, you probably have gastroesophageal reflux disease (GERD). Hiatal hernia and GERD often occur together. If this is the case, your doctor may do more specific tests to confirm a diagnosis. For more information, see the topic Gastroesophageal Reflux Disease (GERD).

Your doctor may find a hiatal hernia while doing a test called an upper gastrointestinal series. This test examines the upper and part of the middle portions of the digestive tract. After you swallow a "shake" made of barium and water, X-rays are taken to track the movement of the barium through the esophagus, the stomach, and the first part of the small intestine (duodenum ) using fluoroscopy connected to a video monitor. See a picture of a fluoroscopic image of a hiatal hernia .

Upper gastrointestinal endoscopy is a procedure that allows your doctor to look at the interior lining of your esophagus, stomach, and duodenum by using a thin, flexible imaging instrument called an endoscope.

If you have shortness of breath or pain in the area of your breastbone, you need to make sure it is not caused by a heart problem. The burning sensation caused by GERD usually occurs after eating. Pain from your heart is usually felt as pressure, heaviness, a weight, tightness, squeezing, discomfort, or a dull ache that occurs most often after activity. To learn more about chest pain that may indicate problems with your heart, see the topic Chest Pain.

Treatment Overview

A sliding hiatal hernia that causes no symptoms generally needs no treatment.

If you have symptoms, you probably have gastroesophageal reflux disease (GERD). Hiatal hernia and GERD often occur together. Your symptoms may vary from mild to severe.

If you have severe GERD symptoms, they often can be treated successfully with medicines. Less commonly, a sliding hiatal hernia can be surgically repaired through fundoplication, a procedure in which the hernia is pulled down from the chest cavity and stitched (sutured) so that it remains within the abdomen (belly). For more information, see the topic Gastroesophageal Reflux Disease (GERD).

Occasional or mild symptoms can generally be treated with home treatment, including lifestyle changes and nonprescription medicines.

If you have a paraesophageal or mixed hiatal hernia, surgery generally is recommended to avoid complications. Consult your doctor.

Home Treatment

If you have a sliding hiatal hernia, usually no treatment is necessary. But you may have occasional or mild symptoms—a feeling of burning, warmth, heat, or pain behind the breastbone (commonly known as heartburn).

You can make changes to your lifestyle to help relieve your symptoms of heartburn. Here are some things to try:

• Change your eating habits.
  • It’s best to eat several small meals instead of two or three large meals.
  • After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea.
  • Chocolate, mint, and alcohol can make heartburn worse. They relax the valve between the esophagus and the stomach.
  • Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make heartburn symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
• Do not smoke or chew tobacco.
• If you get heartburn at night, raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm) by putting the frame on blocks or placing a foam wedge under the head of your mattress. (Adding extra pillows does not work.)
• Avoid or reduce pressure on your stomach. Do not wear tight clothing around your middle. Lose weight if you need to. Losing just 5 to 10 pounds can help.

Along with making lifestyle changes, taking nonprescription medicines may control mild or occasional heartburn. These medicines include acid reducers or blockers and antacids.

If you have symptoms that last longer and occur more often than ordinary heartburn, you probably have gastroesophageal reflux disease (GERD). Hiatal hernia and GERD often occur together. Your symptoms may vary from mild to severe. For more information, see the topic Gastroesophageal Reflux Disease (GERD).

Other Places To Get Help

Organization

Related Information

• Chest Pain
• Gastroesophageal Reflux Disease (GERD)
• Heartburn

References

Citations

1. Jeyarajah R, Harford WV (2006). Diaphragmatic hernias section of Abdominal hernias and gastric volvulus. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 477–498. Philadelphia: Saunders Elsevier.

Other Works Consulted

• Rosemurgy AS (2003). What's new in surgery: Gastrointestinal conditions. Journal of the American College of Surgeons, 197(5): 792–801.

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