What is a hiatal hernia?

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 Hernia Types

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. 

Hiatal Hernia Causes

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:

  • Persistent cough
  • Straining from constipation
  • Obesity
  • Smoking
  • Heavy lifting (usually repetitive, like for an occupation)

Hiatal Hernia Symptoms

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:

  • Chronic belching
  • Regurgitation
  • Anemia
  • Chest or abdominal pain
  • Difficulty swallowing

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

Diagnosis of Hiatal Hernia 

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

  • Chest X-ray
  • 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 backward into the esophagus
  • Manometry: This test diagnoses abnormal muscle movements inside the esophagus
  • CT scan

Hiatal Hernia Treatment

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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