Disease and Condition

A hernia is the protrusion of an organ through the wall that normally contains it. With a hiatal hernia, part of the stomach protrudes upward through the opening (hiatus) at the esophagus and the diaphragm. The stomach is normally located in the abdomen. The esophagus connects the throat to the stomach, and the diaphragm is a group of muscles used for breathing, located between the abdomen and the lungs.


Hiatal hernias are more likely to occur in females than males, and are very common during middle age. People who are obese or have had abdominal surgery are at higher risk for hernias. The risk also increases with age. Hiatal hernias can occur in children and adults.

Causes of Hiatal Hernia

Hiatal hernias are caused by a weakness in the muscle tissue at the opening in the diaphragm where the esophagus passes through to the stomach. In some people, this weakness is congenital, which means it is present at birth. In others, it develops over time, as a result of excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, heavy lifting, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing. Because the muscle is weak, the hernia occurs during abdominal strain.

 Symptoms of Hiatal Hernia

A hiatal hernia cannot be seen on the outside of the body, and may not cause any symptoms at all. Patients who do experience symptoms usually feel a burning sensation in the chest and throat a short time after eating. This is called gastroesophageal reflux and is caused by stomach acids being pushed up into the esophagus. Other symptoms include heartburn, an uncomfortably full feeling after eating, and the frequent need to belch. A serious complication of a hiatal hernia can occur if the part of the stomach that is herniated becomes twisted or pinched by the diaphragm. This is called a strangulated hiatal hernia. If this happens, that portion of the stomach can lose its blood supply. Symptoms include severe chest pain, bloating, and difficulty swallowing. Very large hiatal hernias can develop lesions that bleed and cause anemia from the blood loss.

Diagnosed of Hiatal Hernia

To diagnose a hiatal hernia, your doctor will rely upon your description of symptoms and a series of diagnostic tests. These may include endoscopy or a barium swallow. With endoscopy, a flexible viewing tube is inserted through the mouth and down to the stomach so the doctor can check for the hiatal hernia between the esophagus and the stomach. You will be given a mild sedative during the procedure so you will feel no discomfort. With a barium swallow, x-rays are taken after you drink a special barium solution. The barium helps reveal the bulge of a hiatal hernia on the x-ray. Both tests can be done on an outpatient basis.

Treatment of Hiatal Hernia

The treatment for hiatal hernias is focused on diet and surgery is rarely necessary. Doctors recommend restricting your intake of spicy and acidic foods and beverages, caffeinated beverages, and chocolate; elevating your head when lying down to prevent gastroesophageal reflux; remaining in an upright position after eating; and using antacids and acid-reducing medications. Patients with hiatal hernias find that symptoms are reduced if they eat frequent small meals throughout the day. Surgery is necessary for a strangulated hiatal hernia and very large hiatal hernias that cause severe gastroesophageal reflux. This procedure may be performed through laparoscopic surgery, in which the surgeon uses a special viewing instrument called a laparoscope, inserted through a small incision in the chest or abdomen. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to pull the stomach back down into the abdomen and repair the weak muscle or make a smaller opening between the diaphragm and the esophagus.

Prevented Managment

Although there is no way to prevent hernias due to a congenital weakness, you can help reduce your risk for a hiatal hernia. Follow a healthy diet that is high in fiber and drink plenty of fluids to prevent constipation, maintain a healthy weight through diet and exercise, and avoid cigarette smoking, which can cause chronic coughs. If your job requires heavy lifting, learn the proper way to lift and wear a support garment. Certain medications can aggravate a hiatal hernia. Your doctor can recommend which medications to avoid if you have this condition.