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Hiatus hernia

Key points

  • Hiatus hernia is when part of your stomach slides upwards into your chest, through a hole in your diaphragm.
  • Many people with a hiatus hernia have no symptoms. However, some people develop heartburn.
  • The exact cause of hiatus hernia isn’t known. However, you’re more likely to develop it if you’re overweight and as you get older (over 50).
  • Treatment aims to relieve symptoms. Changing your lifestyle, taking medicines and having surgery are possible treatments.
 

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.

About hiatus hernia

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.

Animation - How a sliding hiatus hernia forms

Animation - How a rolling hiatus hernia forms

Symptoms of hiatus hernia

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:

  • feeling sick or being sick
  • a cough or wheezing when breathing, 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

You can have a hiatus hernia without GORD, and you can have GORD without having a hiatus hernia, but they often go together.

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 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.

Causes of hiatus hernia

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.

Diagnosis of hiatus hernia

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.

  • Endoscopy (also called gastroscopy). This test is done using a narrow, flexible, tube-like telescopic camera called an endoscope. The endoscope is passed down into your stomach through your mouth. Your doctor is able to see images of your oesophagus and stomach on a screen. He or she can also take a biopsy (a tissue sample) at the same time, and stretch any narrowing that has been caused by acid reflux.
  • Sometimes your doctor will arrange for you to have a barium meal X-ray. You may need this if you can’t an endoscopy isn’t suitable for you.

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 of hiatus hernia

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.

Self-help

You can reduce the symptoms of a hiatus hernia and prevent further problems by making the following lifestyle changes.

  • If you’re overweight or obese, lose excess weight.
  • Eat small meals often and try not to eat just before you go to bed.
  • Giving up smoking and cutting down on alcohol will help.
  • Wear loose comfortable clothes.
  • Raise the head of your bed and try not to stoop or bend down.
  • Cut down or stop eating food or drinks that make your symptoms worse. See our frequently asked questions for more information.

Medicines

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.

Surgery

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.

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  • 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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