Hiatal Hernia

The esophagus is the tube that carries food from the mouth to the stomach. It enters the abdominal cavity through a hole in the diaphragm called the esophageal hiatus. When a person has hiatal hernia, the diaphragmatic hiatus is usually weakened or larger than usual. At times, the upper part of the stomach can pass up through this larger-than-usual hole and into the chest cavity.

A person with a hiatal hernia often has no symptoms. The hernia may be found during a test called an upper GI series or during endoscopy.

When symptoms do occur they can include:

• heartburn
• painful swallowing
• burping
• feeling like food is stuck in the throat
• feeling of fullness in the chest
• chest pain
• blood in the stools
• severe pain from constriction of the stomach or esophagus

A hiatal hernia may be caused by:

• constant, harsh coughing
• vomiting
• constipation and straining during bowel movements
• sudden physical exertion
• pregnancy
• obesity
• smoking
• tight clothing around the abdomen
• trauma, causing a hole or tear in the diaphragm
• congenital abnormality, or weakness of the esophageal hiatus present at birth
• esophageal cancer
• medical procedures affecting the esophagus or diaphragm

A person can decrease his or her risk of hiatal hernia by:

• staying at a healthy weight
• limiting smoking and alcohol
• eating a high fiber diet
• not straining during bowel movements
• using proper body mechanics, such as bending at the knees, during heavy lifting
• wearing a seatbelt correctly
• following sports safety guidelines for children, adolescents, and adults

Some causes of hiatal hernia cannot be prevented.

After a complete history and physical, the healthcare provider may order:

• ultrasound, a test that uses sound waves to see the diaphragm and stomach
• endoscopy, a procedure that uses a long tube to look inside the esophagus
• an upper GI series. In this test a person swallows liquid barium, and x-rays are taken to follow the course of the barium through the esophagus and into the stomach.

Hiatal hernias can cause gastroesophageal reflux disease (GERD). GERD is chronic reflux of stomach acid backing up into the esophagus. Ulcers or irritation of the lining of the esophagus and upper stomach can also occur. Strangulation of the esophagus or stomach may also occur with larger hiatal hernias.

Hiatal hernia poses no risk to others.

Treatment of hiatal hernia is focused on treating and reducing symptoms. To reduce symptoms, a person should:

• sleep with the head of the bed raised several inches
• avoid citrus fruits, spicy foods, alcohol, smoking, and caffeine (coffee, tea, chocolate)
• eat small, frequent meals
• maintain a healthy weight, or losing weight if obese
• avoid eating within 2 hours before bedtime
• avoid straining during bowel movements or heavy lifting

Medications that reduce acid production in the stomach or that make the stomach empty faster may help.

Surgery may be needed if symptoms are severe or persistent, or if there is a large hole in the diaphragm. The surgery is done to strengthen the diaphragm and decrease the size of the diaphragmatic hiatus.

Medications that block stomach acid production can cause nausea, headache, or diarrhea. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.

For mild intermittent symptoms, treatment with antacids, watching diet and activity may control hiatal hernia symptoms. For more serious recurrent symptoms, surgery may be needed. Recovery from surgery may be a few days to several weeks depending on the procedure used.

Any new or worsening symptoms should be reported to the healthcare provider.