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.
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.
Frequently Asked Questions
Learning about hiatal hernia:
Living with a hiatal hernia:
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.
A sliding hiatal hernia that causes no symptoms generally needs no treatment.
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.
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
- 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.
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
|National Digestive Diseases Information Clearinghouse (NDDIC)|
|2 Information Way|
|Bethesda, MD 20892-3570|
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.
- 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.
|Editor||Kathleen M. Ariss, MS|
|Associate Editor||Pat Truman, MATC|
|Primary Medical Reviewer||Kathleen Romito, MD - Family Medicine|
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology|
|Last Updated||March 24, 2008|
Last Updated: March 24, 2008