A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.
In most cases, a small hiatal hernia doesn’t cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.
Small hiatal hernias
Most small hiatal hernias cause no signs or symptoms.
Larger hiatal hernias can cause signs and symptoms such as:
- Heartburn
- Belching
- Difficulty swallowing
- Fatigue
A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It’s not always clear why this happens, but pressure on your stomach may contribute to the formation of hiatal hernia.
Hiatal hernia is most common in people who are:
- Age 50 or older
- Obese
A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. Such tests or procedures include:
- An X-ray of your upper digestive tract. During a barium X-ray, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
- Using a scope to see inside your digestive tract. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.
Most people with hiatal hernia don’t experience any signs or symptoms and won’t need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.
If you experience heartburn and acid reflux, your doctor may recommend medications, that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal
In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for emergency situations and for people who aren’t helped by medications to relieve heartburn and acid reflux. Hiatal hernia repair surgery is often combined with surgery for gastroesophageal reflux disease.
An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).