Risk factors include obesity, smoking and an occupation that requires heavy lifting

A hiatal hernia occurs when part of the stomach and/or other intra-abdominal contents have abnormally protruded through the diaphragm into the chest.

Hiatal hernias may be classified into different types depending on the position of the gastro-esophageal junction relative to the diaphragm and the degree to which organs have herniated into the chest. If the gastroesophageal junction remains in its proper place and a fold of the stomach slips into the chest, pressed between the gastroesophageal junction and the diaphragm, this results in a paraesphogeal hernia

The exact cause of hiatal hernias is typically not known but they may result from and be made worse by any condition that results in increased abdominal pressure such as cough, straining from constipation and obesity. The incidence increases with age. Other risk factors include obesity, smoking and an occupation that requires heavy lifting.

Hiatal hernias may not cause any symptoms or may cause heartburn that is worse when you lean forward, strain or lie down. There may be chronic belching and, sometimes, regurgitation (backflow of stomach contents into the throat).

Occasionally, a hiatal hernia can cause anemia from bleeding. This can occur if the wall of the stomach becomes raw from rubbing against the edges of the diaphragm.

Call your doctor if you have persistent heartburn or difficulty swallowing or feel short of breath after a meal. Call your doctor immediately if you develop heartburn accompanied by nausea, vomiting, shortness of breath, palpitations, dizziness or an irregular heartbeat. These may be signs of a heart problem rather than of a hiatal hernia or other digestive disorder.

Hernia-like symptoms should be addressed immediately, as they may develop into more serious problems requiring emergency surgery.

Diagnosis

Your doctor may order one or more of the following tests:

  • Chest X-ray: A simple X-ray may show a large hiatal hernia
  • Esophagoscopy: A thin, lighted tube is inserted down the throat to inspect the esophagus
  • Barium swallow: The path of the barium can outline the position of the hernia in the chest or can show if stomach contents are leaking backwards into the esophagus
  • Manometry: This test will diagnose abnormal muscle movements inside the esophagus

Because many people with hiatal hernias are in the same age group that commonly experiences coronary artery disease and because the symptoms of the two disorders may be very similar, your doctor may order an electrocardiogram (EKG).

Treatment

Most people with hiatal hernias do not require treatment. When a hiatal hernia is associated with reflux symptoms, such as heartburn, you should eat smaller, more frequent meals; avoid eating for at least two hours before going to bed; and sit up for at least one hour after eating. If lifestyle changes do not relieve the symptoms, your doctor will suggest antacids or acid blockers. Many products are on the market, including both over-the-counter and prescription medications.

Fewer than 5 percent of people require surgery. You may need surgery to repair the hernia if you have persistent reflux symptoms or inflammation of the esophagus (esophagitis) that does not heal with medication.

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