Topic Overview
What is a hiatal hernia?
A hiatal hernia (say "hi-AY-tul HER-nee-uh") happens when part of your
stomach bulges up through the diaphragm and into your chest. The
diaphragm is a sheet of muscle that separates your
belly (abdomen) from your chest.
The hernia bulges through the
diaphragm at a place called the hiatus. This is the opening in the diaphragm
that the esophagus passes through. The esophagus is the tube
that connects the throat to the stomach.
There are three main
types of hiatal hernia: sliding,
paraesophageal, and mixed. This topic focuses on
sliding hiatal hernias. See a picture of a
sliding hiatal hernia.
What causes a hiatal hernia?
A hiatal hernia often
is caused by weak muscles and tissue within and around the hiatus.
In a sliding hiatal hernia, a small part of the stomach pushes through
the diaphragm and into the chest. A valve between the esophagus and the stomach
also moves up and away from the diaphragm.
What are the symptoms?
Most people who have a
sliding hiatal hernia have no symptoms.
One symptom you may have
is
heartburn, which is an uncomfortable feeling of
burning, warmth, or pain behind the breastbone. It is common to have heartburn
at night when you are trying to sleep.
If you often have symptoms
or they are severe, you may have
gastroesophageal reflux disease (GERD). A sliding
hiatal hernia can lead to GERD, and people often have both conditions at the
same time.
If you have pain behind your breastbone, it is
important to make sure it is not caused by a problem with your heart. The
burning sensation caused by GERD usually occurs after you eat. Pain from the
heart usually feels like pressure, heaviness, weight, tightness, squeezing,
discomfort, or a dull ache. It occurs most often after you are active.
How is a hiatal hernia diagnosed?
A hiatal hernia
often is diagnosed when you see your doctor or have tests for another health
problem.
If you have symptoms, your doctor will ask you questions
about them. If your symptoms happen often and are severe, you may have
gastroesophageal reflux disease (GERD). If this is the case, your doctor may do
more tests or give you medicine for GERD.
How is it treated?
If you have no symptoms, you don't need treatment.
If you have mild symptoms, your doctor may suggest lifestyle changes and
perhaps
nonprescription medicines. Here are some lifestyle
changes that can help:
- Eat small meals more often instead of two or
three large meals.
- Avoid chocolate, mint, and alcohol.
- Avoid fatty foods.
- Avoid caffeine.
- Don't
smoke or use chewing tobacco.
- Raise the head of your bed by
putting the frame on blocks or placing a foam wedge under the head of your
mattress.
If you often have symptoms or have severe symptoms, you may have GERD. Lifestyle changes may help, and your doctor
may prescribe medicine. In severe cases, surgery can be used to pull the hernia
back into the belly.
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Symptoms
A sliding
hiatal hernia generally has no symptoms.
If symptoms are present, they are usually caused by
acid reflux, the flow of stomach acid into the
esophagus, which may be the result of a weakened
lower esophageal sphincter (LES). Symptoms of reflux
include:
- An uncomfortable feeling of burning, warmth,
heat, or pain behind the breastbone. It may occur after eating, soon after
lying down, or when bending forward. This group of symptoms is commonly known
as
heartburn.
- A sour or bitter taste in the
mouth. The backflow of
stomach acid and juices into the esophagus (known as
acid reflux) may be bad enough to cause this taste in your mouth. This often
occurs along with the symptoms of heartburn, but in some cases it may be your
only symptom.
Other symptoms may include:
- Fullness in the upper belly after a
meal.
- Difficulty swallowing (dysphagia) or a sensation of a lump in
the throat (globus sensation).
- Regurgitation of stomach juices and
nausea.
- A hoarse voice.
If symptoms are continual or severe, you may have
gastroesophageal reflux disease (GERD), which is the
abnormal backflow (reflux) of food, stomach acid, and other digestive juices
into the esophagus that lasts longer and occurs more often than ordinary
heartburn.
Hiatal hernia and GERD often occur together. Treatment
for GERD usually requires prescription medicines, and surgery may be an option.
For more information, see the topic
Gastroesophageal Reflux Disease (GERD).
If you have shortness of breath or pain in the area of your breastbone,
you need to make sure it is not caused by a heart problem. The burning
sensation caused by reflux usually occurs after eating. Pain from your heart is
usually felt as pressure, heaviness, a weight, tightness, squeezing,
discomfort, or a dull ache that occurs most often after activity. To learn more
about chest pain that may indicate problems with your heart, see the topic
Chest Problems.
Large sliding hiatal hernias
may cause a complication called Cameron ulcers, which are erosions on the folds
of the stomach near the opening (hiatus) in the diaphragm where the esophagus
passes through. When
endoscopy is used to view the hernia, Cameron ulcers
are found in about 5% of people with hiatal hernias.1
Sometimes Cameron ulcers can bleed.
Exams and Tests
A sliding
hiatal hernia often is diagnosed when a person is
being evaluated for another health concern. If you go to the doctor with a
feeling of burning, warmth, heat, or pain behind the breastbone (often known as
heartburn), your doctor will probably ask you
questions about your symptoms and may want to do other tests if any of the
following are true:
- You have had heartburn symptoms for a long
time.
- Your symptoms do not get better with medicine.
- Your symptoms promptly come back after medicine is stopped.
- Other serious signs or symptoms are present, such as weight loss,
vomiting of blood, or difficulty swallowing.
If you have symptoms and any of the above are true, you
probably have
gastroesophageal reflux disease (GERD).
Hiatal hernia and GERD often occur together. If this
is the case, your doctor may do more specific tests to confirm a diagnosis. For
more information, see the topic
Gastroesophageal Reflux Disease (GERD).
Your doctor may find a hiatal hernia while doing a test called an
upper gastrointestinal series. This test examines the
upper and part of the middle portions of the digestive tract. After you swallow
a "shake" made of barium and water, X-rays are taken to track the movement of
the barium through the esophagus, the stomach, and the first part of the small
intestine (duodenum) using
fluoroscopy connected to a video monitor. See a
picture of a
fluoroscopic image of a hiatal hernia.
Upper gastrointestinal endoscopy is a procedure that
allows your doctor to look at the interior lining of your esophagus, stomach,
and duodenum by using a thin, flexible imaging instrument called an endoscope.
If you have shortness of breath or pain in the area of your
breastbone, you need to make sure it is not caused by a heart problem. The
burning sensation caused by GERD usually occurs after eating. Pain from your
heart is usually felt as pressure, heaviness, a weight, tightness, squeezing,
discomfort, or a dull ache that occurs most often after activity. To learn more
about chest pain that may indicate problems with your heart, see the topic
Chest Problems.
Treatment Overview
A sliding
hiatal hernia that causes no symptoms generally needs
no treatment.
If you have symptoms, you probably have
gastroesophageal reflux disease (GERD).
Hiatal hernia and GERD often occur together. Your
symptoms may vary from mild to severe.
If you have severe GERD
symptoms, they often can be treated successfully with medicines. Less commonly,
a sliding hiatal hernia can be surgically repaired through
fundoplication, a procedure in which the hernia is
pulled down from the chest cavity and stitched (sutured) so that it remains
within the abdomen (belly). For more information, see the topic
Gastroesophageal Reflux Disease (GERD).
Occasional or mild symptoms can generally be treated with home treatment,
including lifestyle changes and nonprescription medicines.
If you
have a
paraesophageal or mixed hiatal hernia, surgery
generally is recommended to avoid complications. Consult your doctor.
Home Treatment
If you have a sliding
hiatal hernia, usually no treatment is necessary. But
you may have occasional or mild symptoms—a feeling of burning, warmth, heat, or
pain behind the breastbone (commonly known as
heartburn).
You can make changes to your
lifestyle to help relieve your symptoms of heartburn. Here are some things to
try:
- Change your
eating habits.
- It’s best to eat several small meals
instead of two or three large meals.
- After you eat, wait 2 to 3
hours before you lie down. Late-night snacks aren't a good
idea.
- Chocolate, mint, and alcohol can make heartburn worse. They
relax the valve between the esophagus and the stomach.
- Spicy foods,
foods that have a lot of acid (like tomatoes and oranges), and coffee can make
heartburn symptoms worse in some people. If your symptoms are worse after you
eat a certain food, you may want to stop eating that food to see if your
symptoms get better.
- Do not smoke or chew tobacco.
- If you
get heartburn at night, raise the head of your bed
6 in. (15 cm) to
8 in. (20 cm) by putting the
frame on blocks or placing a foam wedge under the head of your mattress.
(Adding extra pillows does not work.)
- Avoid or
reduce pressure on your stomach. Do not wear tight
clothing around your middle. Lose weight if you need to. Losing just 5 to 10
pounds can help.
Along with making lifestyle changes, taking nonprescription
medicines may control mild or occasional heartburn. These medicines include
acid reducers or blockers and
antacids.
If you have symptoms that last
longer and occur more often than ordinary heartburn, you probably have
gastroesophageal reflux disease (GERD).
Hiatal hernia and GERD often occur together. Your
symptoms may vary from mild to severe. For more information, see the topic
Gastroesophageal Reflux Disease (GERD).
Other Places To Get Help
Organization
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National Digestive Diseases Information Clearinghouse
(NDDIC)
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| 2 Information Way |
| Bethesda, MD 20892-3570 |
| Phone: |
1-800-891-5389 |
| Fax: |
(703) 738-4929 |
| E-mail: |
nddic@info.niddk.nih.gov |
| Web Address: |
www.digestive.niddk.nih.gov |
| |
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This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
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References
Citations
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Jeyarajah R, Harford WV (2006). Diaphragmatic hernias
section of Abdominal hernias and gastric volvulus. In M Feldman et al., eds.,
Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 8th ed., vol. 1, pp. 477–498. Philadelphia: Saunders
Elsevier.
Other Works Consulted
- Rosemurgy AS (2003). What's new in surgery:
Gastrointestinal conditions. Journal of the American College of Surgeons, 197(5): 792–801.
Credits
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Author
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Monica Rhodes |
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Editor
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Kathleen M. Ariss, MS |
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Associate Editor
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Pat Truman, MATC |
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Primary Medical Reviewer
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Kathleen Romito, MD - Family Medicine |
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Primary Medical Reviewer
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E. Gregory Thompson, MD - Internal Medicine |
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Specialist Medical Reviewer
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Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology |
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Last Updated
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March 24, 2008 |
