Hiatus hernia

Your health expert: Mr Peter Lamb, Consultant General and Upper Gastrointestinal Surgeon
Content editor review by Pippa Coulter, January 2023
Next review due January 2026

A hiatus hernia (sometimes called a hiatal hernia) is when part of your stomach slides upwards into your chest. This can cause symptoms such as heartburn. You don’t always need treatment for a hiatus hernia. But there are lots of things that can help ease your symptoms.

About hiatus hernia

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. A hiatus hernia is when part of your stomach slides up through this opening and into your chest.

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. These can become very large and include a lot of your stomach. Hiatus hernias are very common. Up to half of adults may have one. It’s hard to say for sure though, as many people don’t have symptoms so won’t know they have one.

Diagram of a sliding hiatus hernia.

Diagram of a rolling hiatus hernia.

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.

You’re at greater risk of developing a hiatus hernia as you get older.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 also increases your risk. This can make your stomach push against the opening in your diaphragm. Things that can increase pressure in your abdomen include:

being obese
pregnancy
having a lung condition, like chronic obstructive pulmonary disorder (COPD), or a long-term cough
long-term constipation
ascites – a condition in which you get a build-up of fluid in your abdomen

Previous surgery or injury to your abdomen or oesophagus may also increase your risk of hiatus hernia.

Symptoms of hiatus hernia

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

But 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 oesophagus. This can include indigestion symptoms such as:

heartburn – a burning sensation in your chest especially when you bend or lie down
reflux of stomach acid into your mouth, especially when you’re lying down – this will taste sour
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

You may notice certain things cause a flare-up of your symptoms. These can include particular foods, medications, drinking alcohol or feeling stressed. See the self-help section below for more information.

When to seek help

You can usually manage symptoms of indigestion, like heartburn, yourself without needing to see a doctor. A pharmacist can support you with this. But there are times when you should contact your GP. These include if:

your symptoms go on longer than a few weeks
your symptoms are getting worse
lifestyle changes and indigestion medicines aren’t working

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

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

Diagnosis of hiatus hernia

Your GP will ask about your symptoms, how they affect you and what could be triggering them. They may also ask about your family history, and examine you too. If you have typical indigestion or GORD symptoms, you may not need tests to diagnose hiatus hernia. Your GP can suggest lifestyle measures and medicines aimed at improving your symptoms.

Your GP may recommend tests if they need to rule out other conditions or if it helps to plan your treatment. They may also refer you to a gastroenterologist for further investigation and assessment. A gastroenterologist is a doctor who specialises in conditions of the digestive system. 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. It can take pictures of the inside of your oesophagus and stomach. If needed, your doctor can also take a biopsy (a tissue sample) at the same time.
Barium swallow and meal. In this test, you drink a fluid containing a substance called barium before having an X-ray. The barium helps to show up your oesophagus and stomach on the 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.

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Self-help for hiatus hernia symptoms

There are a lot of 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. Instead of eating three big meals, aim for several smaller ones 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.
Take note of any foods or drinks that make your heartburn worse, and try to avoid these. See more about trigger foods and a link to our food and symptoms diary below.
If you smoke, try to stop, as smoking may trigger symptoms.
Try to avoid or cut down on alcohol, as this can also be a trigger.

Common examples of foods that trigger hiatus hernia symptoms include:

chocolate
spicy food
fatty food
alcoholic drinks
drinks with caffeine
citrus fruits
tomatoes
fizzy drinks

Try printing and filling out our food and symptoms diary (PDF, 1.4MB) to help you identify foods that cause you problems.

Treatment of hiatus hernia

Treatment for hiatus hernia depends on how severe your symptoms are. You won’t usually need treatment for a hiatus hernia at all if it’s not causing you any problems.

If you’re getting symptoms of indigestion, your doctor will usually suggest things you can do to ease them. These are listed in the self-help section above.

Your doctor will also look at any medicines you’re taking for other conditions. Certain medicines can sometimes trigger symptoms of hiatus hernia or make them worse. 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.

Medicines

The following medicines may help with the symptoms of a hiatus hernia.

Antacids and alginates

These may include calcium, magnesium and aluminium salts, sometimes together with sodium alginate. You can buy these over-the-counter from pharmacies or shops without a prescription. They work by neutralising the acid in your stomach, or forming a barrier over it. They can be helpful for short-term relief of symptoms, but you shouldn’t keep taking them for a long time.

Proton pump inhibitors (PPIs)

Examples include omeprazole (brand names include Losec®, Mezzopram®) and lansoprazole (brand name, Zoton®). They work by reducing the amount of acid your stomach produces. Your doctor may prescribe a PPI if you have ongoing symptoms of indigestion, or confirmed GORD due to a hiatus hernia. You may be offered the treatment for four weeks at first. If it helps, you may need to continue taking PPIs long term. Sometimes you may just be able to take them whenever symptoms flare up.

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 or you don’t get on with them
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. This is usually done as a keyhole (laparoscopic) procedure, but sometimes you may need open surgery. It involves repairing your hiatus hernia and wrapping the top part of your stomach around your lower oesophagus. This can help to control your symptoms as well as reduce your hiatus hernia.

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. They can assess whether surgery would help.

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.

There isn’t always a clear cause for hiatus hernia. But a number of factors may increase your risk of developing one. These may include obesity, pregnancy and anything else that increases pressure in your abdomen. You’re also more likely to get a hiatus hernia as you get older. See our causes section to find out more.

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 for hiatus hernia include fatty and spicy foods. For more details, see our self-help section. You can also use our food and symptoms diary to help identify foods that may cause you problems.

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. See our treatment section to find out more.

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. See our treatment section for more information.

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