A hiatus hernia is when part of the upper stomach slides upwards into the chest. It does this by pushing through the natural opening in the diaphragm muscle through which the oesophagus (the pipe that goes from the mouth to the stomach) passes. Hiatus hernias are common, especially in people over 50.
Your stomach usually sits completely below your diaphragm The diaphragm is the sheet of muscle that separates your chest (where your lungs and heart are) from your abdomen (tummy).
Your diaphragm has an opening in it called the hiatus. Your oesophagus passes through the hiatus. A hiatus hernia develops when part of your stomach slides back up through the hiatus and into your chest.
Hiatus hernia is very common – around three in 10 people over 50 will get it. However, this number may be higher, because many people with a hiatus hernia have very mild symptoms or none at all, and may not realise that they have the condition.
There are two types of hiatus hernia, a sliding hiatus hernia and a rolling hiatus hernia. Around nine out of 10 people with a hiatus hernia have the sliding type. This is when both the stomach and the junction where your oesophagus and stomach meet slide upwards into your chest. A rolling hiatus hernia is where just part of your stomach pushes up into the chest.
Most hiatus hernias don’t cause any symptoms. If you do get symptoms, they are unlikely to be serious.
A sliding hiatus hernia can cause a problem called gastro-oesophageal reflux disease (GORD). This is when acid or bile in the stomach rises back up into your oesophagus.
The most common symptom of GORD is heartburn, which causes a warm or burning sensation in your chest. The burning feeling from heartburn can go all the way up to your throat. You may be more likely to notice heartburn after smoking, drinking alcohol or coffee, or eating chocolate. It can also get worse when you bend over or when you’re lying down.
Other symptoms of hiatus hernia and GORD include:
You can have a hiatus hernia without GORD, and you can have GORD without having a hiatus hernia, but they often go together.
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 can bleed. As the ulcers heal scars can develop, which can narrow your oesophagus. This can cause food to get stuck or to come back up.
Acid reflux can also cause a condition called Barrett’s Oesophagus. This is where the cells that line your oesophagus change and become abnormal. Over time these cells may become cancerous.
A rolling hiatus hernia can sometimes get trapped or pinched by the diaphragm causing the blood supply to be cut off. This is called a strangulated hernia and causes severe pain. If this happens, you will need to have an operation immediately to treat it.
Chronic oesophagitis (long-term inflammation of the lining of the oesophagus) can develop if you have acid reflux over a long period of time. The inflammation causes scarring, which can then cause the oesophagus to shrink and become shorter.
The exact reasons why you may develop a hiatus hernia aren’t fully understood. However, you’re more likely to develop one if you’re very overweight (obese). Being overweight increases the pressure in your abdomen and can push your stomach up into your chest. You’re also more at risk as you get older. This is because as get older the muscles in your diaphragm get weaker.
Hiatus hernias are more common in women than in men. This may be related to the increased pressure in a woman’s abdomen as result of pregnancy.
If your GP thinks you might have a hiatus hernia, he or she will ask you about your symptoms. Your GP may refer you to a gastroenterologist (a doctor who specialises in identifying and treating conditions that affect the digestive system) for tests. Some of the tests your specialist may arrange are listed below.
A hiatus hernias is sometimes discovered when you have a chest X-ray, scan or endoscopy for something else. This is because a hiatus hernia often doesn't cause any symptoms.
Treatment for hiatus hernia generally aims to ease the symptoms of acid reflux. The treatment you need will depend on how severe your symptoms are and how much they are affecting you.
You can reduce the symptoms of a hiatus hernia and prevent further problems by making the following lifestyle changes.
You can take medicines to help reduce the symptoms of reflux from a sliding hiatus hernia. The most common are antacids, which work by neutralising the acid in your stomach. How well antacids work varies from person to person. If you find they don’t relieve your symptoms, your GP or pharmacist may suggest a different medicine. The two main types that you may be prescribed are called H2 receptor antagonists and proton pump inhibitors. Both of these reduce the amount of acid produced by your stomach.
If you have tried other treatments and they haven’t worked, or your symptoms are severe, your doctor may suggest an operation. You will also need to have surgery if a rolling hernia becomes strangulated.
There are a number of different types of operation to repair a hiatus hernia. They involve putting the gastro-oesophageal junction back into your abdomen and tightening up the hiatus (the opening).
Your surgeon will also strengthen the oesophageal sphincter by wrapping the stomach around it. The oesophageal sphincter is a bundle of muscles which stops what is in your stomach from coming back out. This operation is called a fundoplication and is usually done as a laparoscopic (keyhole) procedure. See our frequently asked questions for more information.
Reviewed by Sarah Smith, Bupa Health Information Team, October 2013.
For answers to frequently asked questions on this topic, see FAQs.
For sources and links to further information, see Resources.
This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.
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