What is Hiatal Hernia

Hiatal hernia occurs when part of the stomach slides above the muscle that separates the abdomen from the chest (diaphragm). A person can be born with a hiatal hernia (congenital), or it may develop over time. In almost all cases of hiatal hernia, only the top part of the stomach pushes through the diaphragm.

Many people have a hiatal hernia with no symptoms. The larger the hernia, the more likely it is that you will have symptoms. In some cases, a hiatal hernia allows stomach acid to flow back into the tube that carries food from your mouth to your stomach (esophagus).

This may cause heartburn symptoms. Severe heartburn symptoms may mean that you have developed a condition called gastroesophageal reflux disease (GERD).

What are the causes?

This condition is caused by a weakness in the opening (hiatus) where the esophagus passes through the diaphragm to attach to the upper part of the stomach. A person may be born with a weakness in the hiatus, or a weakness can develop over time.

What increases the risk?

This condition is more likely to develop in:

• Older people. Age is a major risk factor for a hiatal hernia, especially if you are over the age of 50.
• Pregnant women.
• People who are overweight.
• People who have frequent constipation.

What are the signs or symptoms?

Symptoms of this condition usually develop in the form of GERD symptoms. Symptoms include:

• Heartburn.
• Belching.
• Indigestion.
• Trouble swallowing.
• Coughing or wheezing.
• Sore throat.
• Hoarseness.
• Chest pain.
• Nausea and vomiting.

How is this diagnosed?

This condition may be diagnosed during testing for GERD. Tests that may be done include:

• X-rays of your stomach or chest.
• An upper gastrointestinal (GI) series. This is an X-ray exam of your GI tract that is taken after you swallow a chalky liquid that shows up clearly on the X-ray.
• Endoscopy. This is a procedure to look into your stomach using a thin, flexible tube that has a tiny camera and light on the end of it.

How is this treated?

This condition may be treated by:

• Dietary and lifestyle changes to help reduce GERD symptoms.
• Medicines. These may include:
  • Over-the-counter antacids.
  • Medicines that make your stomach empty more quickly.
  • Medicines that block the production of stomach acid (H2 blockers).
  • Stronger medicines to reduce stomach acid (proton pump inhibitors).
• Surgery to repair the hernia, if other treatments are not helping.

If you have no symptoms, you may not need treatment.

Follow these instructions at home:

Lifestyle and activity

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Try to achieve and maintain a healthy body weight.
• Avoid putting pressure on your abdomen. Anything that puts pressure on your abdomen increases the amount of acid that may be pushed up into your esophagus.
  • Avoid bending over, especially after eating.
  • Raise the head of your bed by putting blocks under the legs. This keeps your head and esophagus higher than your stomach.
  • Do not wear tight clothing around your chest or stomach.
  • Try not to strain when having a bowel movement, when urinating, or when lifting heavy objects.

Eating and drinking

• Avoid foods that can worsen GERD symptoms. These may include:
  • Fatty foods, like fried foods.
  • Citrus fruits, like oranges or lemon.
  • Other foods and drinks that contain acid, like orange juice or tomatoes.
  • Spicy food.
  • Chocolate.
• Eat frequent small meals instead of three large meals a day. This helps prevent your stomach from getting too full.
  • Eat slowly.
  • Do not lie down right after eating.
  • Do not eat 1–2 hours before bed.
• Do not drink beverages with caffeine. These include cola, coffee, cocoa, and tea.
• Do not drink alcohol.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your symptoms are not controlled with medicines or lifestyle changes.
• You are having trouble swallowing.
• You have coughing or wheezing that will not go away.

Get help right away if:

• Your pain is getting worse.
• Your pain spreads to your arms, neck, jaw, teeth, or back.
• You have shortness of breath.
• You sweat for no reason.
• You feel sick to your stomach (nauseous) or you vomit.
• You vomit blood.
• You have bright red blood in your stools.
• You have black, tarry stools.