Hiatus hernia

Expert review by:

Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon

Content review by:

Pippa Coulter, Freelance Health Editor

Page last reviewed: January 2023
Next review date: January 2026

Key points

A hiatus hernia happens when part of your stomach moves upwards into your chest.
Hiatus hernia can cause symptoms like heartburn, but many people don’t have any symptoms.
Risk factors for hiatus hernia include older age and conditions such as obesity and pregnancy.
Treatment for hiatus hernia may not be needed, but it can include lifestyle changes, medications, or surgery.

What is hiatus hernia?

A hiatus hernia (sometimes called a hiatal hernia) is when part of your stomach slides upwards into your chest. Usually, your stomach sits completely below a sheet of muscle, called your diaphragm. This separates your chest from your abdomen (tummy). There’s an opening (‘hiatus’) in your diaphragm to let through a tube called your oesophagus. Your oesophagus carries food from your mouth to your stomach.

There are two main types of hiatus hernia: sliding hiatus hernia and rolling hiatus hernia. You can also have a mixed hiatus hernia, which is a combination of these types.

You don’t always need treatment for a hiatus hernia.

Symptoms of hiatus hernia

Many people with a hiatus hernia don’t have any symptoms.

If you have a sliding hiatus hernia, you may develop gastro-oesophageal reflux disease (GORD). This is when acid from your stomach travels back up your food pipe (oesophagus). This can include indigestion symptoms such as:

heartburn – a burning sensation in your chest
reflux of stomach acid into your mouth – causing a sour taste
feeling or being sick
feeling bloated, or getting full quickly
coughing or wheezing, or feeling short of breath
pain in your chest or upper abdomen (tummy)
finding it difficult or painful to swallow

When to seek help

You can usually manage symptoms of indigestion, like heartburn, yourself. A pharmacist can also advise you on this. But there are times when you should contact your GP. These include if your symptoms last longer than a few weeks, get worse, or if treatment isn’t working.

There are also some circumstances when you should seek urgent medical advice. These include if you are:

having difficulty swallowing
over 55 and have other symptoms – such as losing weight or blood in your vomit

Treatment of hiatus hernia

Treatment for hiatus hernia depends on how severe your symptoms are. There are things you can do to ease or prevent them. There are also medicines that may help with symptoms, and sometimes, surgery for hiatus hernia may be an option.

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Self-help for hiatus hernia symptoms

There are several things you can do to ease or prevent the symptoms of a hiatus hernia. These include the following.

If you’re obese or overweight, try to lose any excess weight.
Avoid large meals. Aim for several smaller meals throughout the day.
If heartburn bothers you at night, try raising the head of your bed. Don’t eat anything for at least three hours before you go to bed.
Try to avoid things that raise the pressure inside your abdomen (tummy). This might include wearing tight clothing around your middle.
If you smoke, try to stop, as smoking may trigger symptoms.

Which foods should I avoid if I have a hiatus hernia?

If you have symptoms such as heartburn caused by a hiatus hernia, you may find that avoiding certain foods helps prevent these. Common trigger foods include:

fatty and spicy foods
alcohol
caffeine

A food and symptoms diary (PDF, 1.4MB) may help you identify foods that cause you problems.

Medicines

Certain medicines can trigger or worsen symptoms of hiatus hernia. Your doctor may suggest reducing or stopping the medicine if so. Don’t stop any medicines without advice from a doctor.

Your doctor may also recommend or prescribe indigestion medicines. These can help to ease your symptoms, but they won’t cure your hiatus hernia. These medicines include:

antacids and alginates, which neutralise the acid in your stomach or form a barrier over it
proton pump inhibitors (PPIs), which reduce the amount of acid your stomach produces

Surgery

There are certain circumstances when surgery for hiatus hernia may be an option. These include if:

medicines aren’t controlling your symptoms or you need high doses to control your symptoms
you can’t tolerate the side-effects of medicines
you don’t want to take medicines long-term
you have a rolling or a mixed hiatus hernia with symptoms

Your GP will need to refer you to a specialist surgeon to discuss whether surgery may be an option for you. The most common surgical treatment for a hiatus hernia is an operation called a fundoplication.

What can I take to ease hiatus hernia pain?

You can take over-the-counter indigestion medicines to manage symptoms such as heartburn. You can buy these from a shop or pharmacy, without a prescription from your doctor. But you should only take these for short periods of time. If you need something more, talk to your pharmacist or GP about other medicines that may help.

What happens if I don’t fix my hiatus hernia?

A hiatus hernia doesn’t always need to be fixed. You’ll usually only need treatment if it’s causing you symptoms. You can often manage hiatus hernia symptoms with lifestyle changes and medicines. If you don’t have surgery to fix the hiatus hernia, you might need to continue with these measures over the long term.

Types of hiatus hernia

There are two main types of hiatus hernia.

Sliding hiatus hernia. The area where your oesophagus and stomach join is called the gastro-oesophageal junction. In this type, the gastro-oesophageal junction slides up into your chest first. The top part of your stomach then follows. Around 9 in 10 people with a hiatus hernia have this type.
Rolling hiatus hernia (also called a para-oesophageal hiatus hernia). In this type, a different part of your stomach passes up into your chest to lie alongside your oesophagus. Your gastro-oesophageal junction stays in place below your diaphragm. Only around 1 in 10 people have this type.

You can also have a mixed hiatus hernia, which is a combination of these types.

It’s thought that up to half of adults have a hiatus hernia, so they’re very common.

Hiatus hernia causes

It’s not always clear exactly what causes a hiatus hernia. But there are certain factors that can make you more likely to develop one, including:

older age – this is thought to be because the muscles in your diaphragm get weaker and less flexible as you get older
anything that increases the pressure in your abdomen, such as obesity, pregnancy, a lung condition, long-term constipation, or ascites (build-up of fluid in your abdomen)
previous surgery or injury to your abdomen or oesophagus

Diagnosis of hiatus hernia

To diagnose a hiatus hernia, a GP may:

ask you about your symptoms and what could be triggering them
examine you
recommend tests to rule out other conditions or plan your treatment
refer you to a doctor who specialises in conditions of the digestive system (a gastroenterologist)

If you have typical indigestion or GORD symptoms, you may not need tests to diagnose hiatus hernia.

Tests for hiatus hernia include the following.

An endoscopy (also called a gastroscopy). This involves passing an endoscope (tube-like flexible camera) into your mouth or nose, and down into your stomach.
Barium swallow and meal. In this test, you drink a fluid containing a substance called barium, which helps to show up your oesophagus and stomach on an X-ray.
Oesophageal function tests. These look at how well your oesophagus is working and monitor any reflux you have. The test involves passing a fine tube (catheter) into your nose and down into your oesophagus. Your doctor may recommend this if you’re considering surgery.

Complications of hiatus hernia

There can be long-term complications associated with GORD due to a hiatus hernia. These include the following.

Inflammation of your oesophagus (oesophagitis). Your oesophagus can become damaged by the acid from your stomach. This can lead to ulcers which may bleed.
Anaemia caused by bleeding from an ulcer in your oesophagus.
Narrowed oesophagus (a stricture). This is caused by scarring of your oesophagus from repeated inflammation. This can cause food to get stuck or to come back up.
Aspiration pneumonia. This is when you breathe food or drink into your airways. It can then cause an infection in your lung.
Barrett’s oesophagus. This is where the cells that line your oesophagus become damaged. Eventually, these cells may become cancerous.

Your doctor may suggest referral to an upper GI surgeon if you have signs of developing these complications.

If you have a larger rolling or mixed hernia, your stomach can turn and get twisted as it moves into your chest. This is called strangulation and results in the blood supply to your stomach being cut off, causing severe pain. This is an emergency and you’ll need urgent surgery to correct it.

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