Patient education: Hiatal hernia (The Basics)

What is a hiatal hernia? — A hiatal hernia is when a part of the stomach moves up into the chest area. Normally, the stomach sits below the diaphragm. The diaphragm is the layer of muscle that separates the organs in the chest from the organs in the belly. The esophagus, the tube that carries food from the mouth to the stomach, passes through a hole in the diaphragm. In people with a hiatal hernia, the stomach pushes up through that hole, too.

There are 2 types of hiatal hernia (figure 1):

●Sliding hernia – This is when the top of the stomach and the lower part of the esophagus squeeze up into the space above the diaphragm. This is the most common type of hiatal hernia.

●Paraesophageal hernia – This is when the top of the stomach squeezes up into the space above the diaphragm. This is not very common, but it can be serious if the stomach folds up on itself. It can also cause bleeding from the stomach or trouble breathing.

What are the symptoms of a hiatal hernia? — A hiatal hernia does not usually cause symptoms. In some cases, though, it can cause stomach acid to leak into the esophagus. This is called "acid reflux" or "gastroesophageal reflux." It can cause symptoms like:

●Burning in the chest, known as heartburn

●Burning in the throat or an acid taste in the throat

●Stomach or chest pain

●Trouble swallowing

●A raspy voice or a sore throat

●Unexplained cough

Is there a test for hiatal hernia? — Yes. But in most cases, people learn they have a hiatal hernia when they are having tests to find the cause of symptoms, or for other reasons. For instance, some people find out they have a hiatal hernia when they get an X-ray. Others find out when their doctor does a test called an "endoscopy." This test involves putting a tube with a tiny camera down the throat (figure 2).

How are hiatal hernias treated? — People who have symptoms caused by a hiatal hernia can get treatment for their symptoms.

Treatment for symptoms involves taking the medicines that are used for acid reflux (table 1). People with a paraesophageal hernia, and some people with a sliding hernia, need surgery. For this surgery, the surgeon pulls the stomach back down and repairs the hole in the diaphragm. This way, the stomach does not slide up again.

More on this topic

Patient education: Acid reflux and gastroesophageal reflux disease in adults (The Basics)

Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics)