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Hiatus hernia

A hiatus hernia usually happens when the top part of your stomach slides upwards into your chest. It’s a common condition, affecting nearly a third of people over 50. Not everyone has symptoms, but the main one is heartburn.

Most of the time, you’ll be able to manage a hiatus hernia by making lifestyle changes and taking medicines. Some people need surgery to repair a hiatus hernia.

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Details

  • About What happens with a hiatus hernia?

    To understand how a hiatus hernia happens, it helps to know more about the structures inside your body.

    You have a sheet of muscle, called your diaphragm, which separates your chest from your abdomen (tummy). Usually, your stomach sits completely below your diaphragm.

    When you swallow your food, it passes down a tube called your oesophagus to your stomach. Your oesophagus passes through an opening in your diaphragm, called the hiatus. A hiatus hernia usually develops when part of your stomach slides back up through this opening and into your chest.

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  • Types What are the types of hiatus hernia?

    There are two types of hiatus hernia: a sliding hiatus hernia and a rolling hiatus hernia. Around eight out of 10 people with a hiatus hernia have the sliding type. This is when both your stomach, and the place where your oesophagus and stomach meet (known as the gastro-oesophageal junction), slide upwards into your chest.

    A rolling hiatus hernia is where just part of your stomach pushes up into the chest. It ends up alongside your oesophagus. This type is more of a problem and you’re likely to need an operation if you have this.

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  • Symptoms Symptoms of hiatus hernia

    Sometimes a hiatus hernia doesn’t cause any symptoms.

    However, a sliding hiatus hernia can cause a problem called gastro-oesophageal reflux disease (GORD). This is when acid in your stomach rises back up into your oesophagus. Sometimes it’s called by a shorter name – acid reflux.

    The main symptom of GORD is heartburn, which causes a warm or burning sensation in your chest and throat.

    Other symptoms of hiatus hernia and GORD include:

    • feeling or being sick
    • coughing or wheezing, especially at night – this is caused by breathing in the acid that has come up from your stomach
    • your mouth filling with saliva
    • finding it difficult or painful to swallow

    Not everyone with a hiatus hernia has GORD, but they often go together.

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  • Diagnosis Diagnosis of hiatus hernia

    Your GP may be able to recommend treatments to help your symptoms of heartburn without any need for tests or a formal diagnosis.

    If your symptoms are more severe, or you’ve over the age of 55, your GP may refer you to a gastroenterologist (a doctor who specialises in the digestive system) for tests.  

    The gastroenterologist may suggest you have a barium meal X-ray. In this test, you swallow a substance that helps to show up your digestive system on an X-ray.

    Another test your specialist may advise is an endoscopy (also called a gastroscopy). This test is done using a tube with a camera on the end, called an endoscope. The endoscope is passed through your mouth and down into your stomach. Your doctor can see images of the inside of your oesophagus and stomach on a screen. He or she can also take a biopsy (a tissue sample) at the same time. 

    A hiatus hernia is sometimes discovered by chance when you have a test for something else. This is because a hiatus hernia doesn't always cause symptoms.

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  • Treatment Treatment of hiatus hernia

    The treatment you’re offered will depend on how severe your symptoms are and how much they’re bothering you.

    Self-help

    There’s a lot you can do to ease the symptoms of a hiatus hernia, and prevent further problems.

    • If you need to lose weight, this can make a big difference to your symptoms. You might like to try following our practical weight loss advice.
    • Giving up smoking is a sensible step. Try our tools to help you stop smoking for good.
    • Cutting down on alcohol will also help.
    • Instead of eating three big meals, aim for several smaller ones throughout the day.  
    • Try not to eat just before bedtime.
    • Raise the head of your bed if heartburn bothers you at night.  
    • If you notice that some foods and drinks make your heartburn worse, try cutting them out. Some of these might include coffee, chocolate, and fatty foods. There’s more detailed advice in the section on food and drinks below.

    Medicines

    There are numerous indigestion medicines available that can ease the symptoms of heartburn. You can buy many of these from your pharmacist without a prescription. But your doctor can advise which treatment may be best for you, depending on your symptoms.

    Your doctor may recommend some of the following medicines.

    • Antacids – these work by neutralising the acid produced in your stomach.
    • Alginates (for example, Gaviscon) – these form a raft that floats on top of your food and stomach acid, making a barrier.
    • Proton pump inhibitors (PPIs) – these work by reducing the amount of acid your stomach produces.
    • H2 receptor antagonists – these also reduce the amount of acid produced by your stomach.

    Surgery

    If other treatments haven’t worked and your symptoms are severe, your doctor may suggest an operation.

    There are a number of different types of operation to repair a hiatus hernia. They all involve putting the top part of your stomach back into your abdomen and tightening the opening in your diaphragm.

    Your surgeon may also strengthen the ring of muscles that stops acid and food coming up from your stomach and into your oesophagus. This procedure is called a fundoplication.

    If you have a rolling hernia, your doctor may also recommend an operation to prevent it from becoming trapped (strangulated). You’ll need urgent surgery if you have a rolling hernia that does become strangulated.

    Our guide to living with a hiatus hernia can help you understand what makes your symptoms better or worse and the treatment options available to you so you can manage your condition in a way that suits you.

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  • Causes Causes of hiatus hernia

    It’s not clear exactly why some people develop a hiatus hernia. However, people who are obese (very overweight) are more likely to develop one. You’re also more likely to develop a hiatus hernia as you get older. This might be because the muscles in your diaphragm get weaker.

    Hiatus hernia can also happen during pregnancy. The condition is more common in smokers.

  • Complications Complications of hiatus hernia

    Occasionally, a hiatus hernia can lead to more serious problems. Your oesophagus can become damaged by the acid from your stomach, and this can lead to ulcers. These ulcers can be painful when you swallow and they may bleed. As the ulcers heal, scars can develop, which may narrow your oesophagus. This can cause food to get stuck or to come back up.

    If you have a hiatus hernia, you may have acid coming up from your stomach into your oesophagus. Over time, this can cause a condition called Barrett’s oesophagus. This is where the cells that line your oesophagus change and become abnormal. Eventually, these cells may become cancerous. If you have Barrett’s oesophagus, your doctor will monitor cells in your oesophagus to spot and then treat any changes quickly.

    A rolling hiatus hernia can sometimes get trapped or pinched by the diaphragm, cutting off the blood supply. This is called a strangulated hernia and causes severe pain. If this happens, you’ll need an operation immediately.

  • FAQ: Obesity and hiatus hernia I am overweight and often get heartburn. Could I have a hiatus hernia?

    People who are overweight are more likely to get heartburn and indigestion. They’re also more likely to develop a hiatus hernia.

    More information

    The exact reasons for this link aren’t known. However, being overweight can increase the pressure inside your abdomen (tummy). This forces acid from your stomach up into your oesophagus, causing heartburn.

    Heartburn is a common symptom of a hiatus hernia. Other symptoms include finding it difficult or painful to swallow, feeling sick or being sick, and coughing or wheezing. Contact your GP if you have any of these symptoms or if you think you might have a hiatus hernia.

  • FAQ: Food and drink Which foods and drinks make the symptoms of hiatus hernia worse?

    Certain foods can make symptoms of hiatus hernia worse. The triggers are different for everyone, but you might find some of the following foods make your symptoms worse:

    • chocolate
    • spicy food
    • fatty food
    • alcoholic drinks
    • drinks with caffeine
    • citrus fruits and fruit drinks
    • tomatoes
    • onions

    Try to keep a record to see what foods trigger your symptoms. You can then try to avoid them in your diet.

    More information

    Making changes to your lifestyle can help control the symptoms of heartburn. When it comes to diet, the evidence isn’t clear,  but some foods might make your symptoms worse. The most important thing is that you keep following a healthy diet. You could try keeping a food diary. Then if you notice that some foods make your heartburn worse, try to avoid them.

  • FAQ: Risks of surgery What are the risks of surgery for a hiatus hernia?

    Everyone is different, but some common problems after hiatus hernia surgery include difficulties in swallowing, and feeling full and uncomfortable, especially after eating.

    More information

    As with any treatment, you’ll need to weigh up the possible benefits and risks of having surgery for hiatus hernia. Your doctor will help you to do this.

    If a rolling hiatus hernia gets trapped (strangulated), you’ll need urgent surgery. Sometimes your doctor will advise you to have an operation to prevent this from happening.

    Talk to your doctor about the risks of having or not having surgery to decide what’s best for you.  

    Some possible complications from surgery include:

    • a bloated feeling, especially after you’ve eaten  
    • difficult or painful swallowing  
    • diarrhoea  

    Sometimes the benefits of the operation don’t last and it may need to be done again. If your symptoms come back after your operation, talk to your surgeon.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Gastroenterology. Oxford handbook of clinical medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, 2014
    • Hiatal hernia. BMJ Best Practice. bestpractice.bmj.com reviewed 21 September 2015
    • Endoscopy. Cancer Research UK. www.cancerresearchuk.org, reviewed 22 April 2015
    • Esophagus anatomy. Medscape. www.emedicine.medscape.com, published 20 July 2015
    • Sands BE. Mount Sinai Expert Guides: Gastroenterology. 1st ed. Chichester: John Wiley & Sons, 2015: 101–10
    • Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ 2014; 349:g6154.
    • Barium X-ray. Cancer Research UK. www.cancerresearchuk.org, reviewed 12 April 2015
    • Dyspepsia and gastro-oesophageal reflux disease: investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both (CG184). National Institute for Health and Care Excellence. 2014. www.nice.org.uk
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.evidence.nhs.uk/formulary/bnf/current, accessed 23 September 2015
    • Bredenoord AJ, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet 2013; 381(9881): 1933–42.
    • Hiatus hernia. PatientPlus. www.patient.info/patientplus, reviewed 28 February 2014
    • Guidelines for the management of hiatal hernia. Society of American Gastrointestinal and Endoscopic Surgeons, 2013. www.sages.org
    • Surgery. Oxford handbook of clinical medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, 2014
    • Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), June 2015. www.nice.org.uk
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    Reviewed by Pippa Coulter, Specialist health editor, Bupa Health Content Team, December 2015.

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