Gokulakrishnan Balasubramanian, MD
A hiatal hernia is an esophageal condition that occurs when part of the stomach 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.
A less common type of hiatal hernia is a paraesophageal hernia, which happens 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.
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:
Hiatal hernias may not cause any symptoms or may cause heartburn that is worse when you lean forward, strain or lie down.
Other symptoms include:
Hernia-like symptoms should be addressed immediately, as they may develop into more serious problems requiring emergency surgery.
Your doctor may order one or more of the following tests:
Most people with hiatal hernias do not require surgical treatment. When associated with reflux symptoms, hiatal hernias can be treated similarly to heartburn, which could include lifestyle modifications or medications like proton pump inhibitors or other acid blockers.
Fewer than 5 percent of people with hiatal hernias 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. Surgical hernia repair is often done laparoscopically, which allows for a shorter hospital stay, less pain and a quicker recovery.
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