Sometimes a hiatal hernia doesn’t cause any problems at all and doesn’t require any treatment. But in other cases, the narrow opening in your diaphragm can squeeze the part of the stomach that it surrounds, causing retention of stomach acid and other contents. These contents can back up into your esophagus, causing heartburn and other symptoms.
Types of Hiatal Hernias
There are two main types of hiatal hernias: Sliding Hiatal Hernia This is when part of your stomach intermittently slides up into your chest through the opening in your diaphragm for your esophagus. The vast majority of hiatal hernias are sliding, also known as type 1. Paraesophageal Hiatal Hernia This is when part of your stomach pushes through the opening in your diaphragm next to your esophagus, so that both your esophagus and part of your stomach are squeezed together in the hiatus.
HeartburnAcidic or sour taste in your mouth or throatRegurgitation of foods or beverages into your mouthBloated feeling in your abdomenFrequent belching (burping)Chest or abdominal painDifficulty swallowingShortness of breathVomiting blood or passing black stools (signs of gastrointestinal bleeding)
A hiatal hernia can also lead to gastroesophageal reflux disease (GERD), a chronic disease characterized by frequent bouts with the above symptoms. The specific causes of a weakened diaphragm aren’t always clear, but the following factors may play a role:
Age-related changes to your diaphragmInjury from trauma or surgeryBeing born with a large hiatus (opening in the diaphragm)
A weakened diaphragm usually isn’t enough to cause a hiatal hernia — you also need increased pressure in your abdomen to push the stomach up through the diaphragm. Hiatal hernias can occur at any age and affect both sexes, but certain factors increase the likelihood, including being over age 50, being overweight, smoking, and pregnancy. Increased abdominal pressure can also come from the following factors:
CoughingVomitingStraining during bowel movementsStrenuous exerciseLifting heavy objects
If you’re experiencing frequent heartburn or chest or abdominal pain, your doctor will probably order tests to look for the cause of your symptoms. These tests may include: Barium Swallow After drinking a chalky liquid containing barium, you’ll undergo an X-ray which allows your doctor to see the outline of your upper digestive tract. Esophageal Manometry This test measures muscle contractions in your esophagus when you swallow to assess its strength and muscle coordination. pH Test A pH test measures the acid levels in your esophagus and can help determine whether your symptoms are related to acid reflux. Recommended lifestyle changes are generally aimed at reducing symptoms of GERD and may include losing weight, avoiding acidic, fried, or fatty foods, and quitting smoking. Your doctor may also recommend the following medications to treat GERD: Antacids These drugs neutralize stomach acid; over-the-counter antacids include brands like Mylanta, Rolaids, and Tums. H2-Receptor Blockers These drugs reduce acid production and include famotidine (Pepcid), cimetidine (Tagamet), nizatidine (Axid), and (ranitidine (Zantac). Surgery may also be needed if you have a strangulated hernia or severe GERD that isn’t responding well to lifestyle measures and medication. To surgically repair a hiatal hernia, your doctor will pull the entire stomach back down into your abdomen and make the opening in your diaphragm smaller. If needed, your surgeon may also repair your esophageal sphincter — the muscle that normally prevents your stomach contents from flowing back into your esophagus. This surgery is usually done laparoscopically — involving several small incisions and using a flexible tube containing a light and camera to view the inside of your abdomen and chest.
Prevention of a Hiatal Hernia
It is difficult to prevent a hiatal hernia, but there are steps you can take to reduce your risk and minimize any symptoms. These include maintaining a healthy weight and not smoking. If you have a hiatal hernia that leads to GERD, the following lifestyle changes can help prevent episodes of GERD:
Losing weightReducing meal and portion sizeAvoiding acidic foods, like tomatoes and citrus fruitAvoiding caffeine and alcoholLimiting carbonated beveragesLimiting fried and fatty foodsEating at least three to four hours before lying downKeeping your head and torso elevated at least 6 inches when you rest or sleepQuitting smoking
Although a hiatal hernia can cause GERD, not all people with a hiatal hernia develop GERD — and most people with GERD don’t have a hiatal hernia. Other complications of a hiatal hernia include lung problems or pneumonia, which can occur when stomach contents move up to the lungs. Finally, if the stomach is being squeezed so tightly that its blood supply is cut off, this is called strangulation of the hernia and emergency surgery is needed. In addition to chest pain, other signs of a heart attack include:
Pain or discomfort in one or both arms, back, neck, or jawDizzinessNauseaVomitingShortness of breathHeart palpitationsIrregular heartbeat
IFFGD is a nonprofit organization dedicated to education and research for all gastrointestinal (GI) disorders. Get essential facts on GI issues like living with a hiatal hernia and heartburn, and read personal stories from people who are dealing with the same health problems. Cleveland Clinic The Cleveland Clinic provides a thorough overview of what it’s like living with a hiatal hernia, as well as information on diagnostic tests and treatment. Additional reporting by Ashley Welch.
