What is Hiatal Hernia (Hiatus Hernia)?
A hiatal hernia (hiatus hernia) happens when the top of the stomach bulges through an opening in the diaphragm.
It is a common condition in people aged 50 years and over. In fact, up to 60 percent of people might have had a hiatal hernia (hiatus hernia) by the time they are 60 years old. (1)
Many people may not be aware they have this condition as it often causes no problems. (2)
The diaphragm is a muscle which separates the lungs from the rest of the abdomen. Domed in shape, it contracts and then flattens when a person inhales deeply.
Located on the left side of the diaphragm is a small opening, which allows the food pipe (esophagus) to pass into the stomach. This hole, which is called the hiatus, usually fits snugly around the food pipe. The stomach is located below the diaphragm.
A hiatal hernia (hiatus hernia) occurs when the hole in the diaphragm becomes weak and gets bigger. This allows part of the stomach to enter the chest area.
There is a muscle at the top of the stomach which separates it from the esophagus (esophageal sphincter). This can also be weakened by the condition. (3)
The exact reason why this happens is not known. It could be hereditary or might be due to other factors such as obesity, or strenuous exercise, like lifting weights. Coughing, vomiting or straining when passing stools may also contribute. (4)
The symptoms of hiatal hernia (hiatus hernia) are similar to those associated with acid reflux or gastroesophageal reflux. They include:
Many people experience heartburn after eating a large meal. However, if this happens frequently, it could be an indication of a hiatal hernia (hiatus hernia).
Heartburn is caused by stomach acid entering the esophagus and irritating the lining.
This causes a pain which can be described as a burning sensation in the chest. The more frequently this happens, and the more fluids escaping from the stomach, the worse the pain will be. (5)
Belching generally happens after we eat too much or drink something fizzy. It is a way of letting excess gas out of the stomach.
People with hiatal hernia might find they burp more than usual. The gas could also burn the throat and taste acidic, especially when stomach contents escape with the gas. (6)
Indigestion (dyspepsia) can produce a number of different symptoms in relation to the stomach. Persistent indigestion could be a sign of acid reflux caused by a hiatal hernia (hiatus hernia).
The associated symptoms include stomach cramps, bloating and nausea. The stomach might also make a gurgling or growling noise. (7)
The unpleasant feeling of food and acid re-entering the throat is another symptom of a hiatal hernia (hiatus hernia). This will often leave an acidic, sour or bitter taste in the mouth. It might also cause some individuals to vomit. (8)
Stomach acid travelling frequently up the esophagus may affect the windpipe. It can make the throat feel dry and result in a persistent cough.
This cough will often be very dry and harsh; it is sometimes strong and violent enough to interfere with a person’s sleep. (9)
A person’s vocal cords are located in the throat. Constant exposure to acid entering the throat and esophagus can cause changes to the voice. It could become raspy or hoarse; it may also lose volume and change frequency. (10)
The main causes of bad breath (halitosis) are problems in the mouth or respiratory tract. However, some people with hiatal hernia (hiatus hernia) also report experiencing bad breath. (11)
A hiatal hernia (hiatus hernia) can result in difficulty swallowing food (dysphagia). This could be due to recurrent inflammation narrowing the esophagus. Swallowing might also be quite painful. (12)
There are no stages associated with hiatal hernia. There are, however, several different types.
Type I – Sliding Hiatal Hernia
This is the most common type of the condition, accounting for up to 95 percent of cases. The part of the stomach which is herniated slides in and out of the chest area.
This type of hernia is usually small and might not present any symptoms. As it causes no problems, the sufferer may be unaware they have this condition.
However, symptoms of gastroesophageal reflux might be present, and become worse if the hernia enlarges.
Type II – Fixed Hiatal Hernia
The top of the stomach in this type of hernia is permanently located in the chest. It has pushed through the gap in the abdomen and stayed there (paraesophageal hernia).
There is potential in this hernia for the stomach to twist, cutting off the passage of food from the esophagus (strangulated hernia).
This type of hernia can become larger over time, requiring surgical intervention to correct it.
This is a combination of the previous two. The difference being that the place where the stomach and esophagus meet (gastroesophageal junction) has also moved above the diaphragm.
This type of hernia involves the displacement of other organs, such as the pancreas, spleen or colon, into the space above the diaphragm.
It can be described as a complicated form of hernia, where the gap in the diaphragm has stretched and enlarged. This abnormality is sufficient to allow the stomach and other organs to enter the chest cavity. (13)
Treatment for this condition is usually only necessary when there are symptoms which cause discomfort. These are generally acid reflux and heartburn, or problems swallowing.
Changes to your lifestyle can help relieve the symptoms of a hiatal hernia (hiatus hernia) and the associated acid reflux.
Some foods can increase the chance of acid reflux. These include chocolate, acidic foods, such as tomatoes, spicy or greasy foods, peppermint and coffee. Avoiding these foods can help. (14)
Other lifestyle choices, like smoking and alcohol, should be avoided.
The acidic nature of alcoholic drinks, especially hard liquor, damages the mucus in the stomach and esophagus. It also plays a part in relaxing the sphincter, which – along with a hernia – can allow reflux. (15)
Smoking cigarettes can interfere with the production of saliva. The act of smoking also affects the pressure in the esophagus and can cause the sphincter to relax. Consequently, stomach acid is more likely to reflux and cause heartburn. (16)
Being overweight can predispose a person to heartburn, especially when excess weight is around the abdomen. The increased pressure this creates adds to the chances of acid reflux. (17)
Eating little and often can help. Avoid eating late at night, within about two to three hours before going to bed.
Lying down also affects acid reflux, especially if you eat close to bedtime. The position in which you sleep can also have an effect. A study has shown that elevating the upper part of the body and sleeping left side down is beneficial. (18,19)
Bending, abdominal exercises, girdles and tight belts can all increase abdominal pressure. (20)
There are medicines available to treat the symptoms, either over the counter or by prescription.
Antacids, which neutralize stomach acid, are readily available. A pharmacist can advise which might be suitable for the patient.
Proton pump inhibitors, such as omeprazole, block the production of acid and allow the esophagus to heal, reducing inflammation.
H2 receptor blockers, such as cimetidine and ranitidine, reduce the amount of acid produced in the stomach.
Prokinetics or antibiotics could also be prescribed by your doctor. Both can help the stomach empty faster. (21)
Surgery for a hiatal hernia (hiatus hernia) will generally only be considered when other treatments have not worked, or if there are complications.
The correction of this condition is usually done via keyhole surgery, under general anesthetic.
However, recovery can be lengthy, and the surgery is not guaranteed to succeed. Further treatment may be necessary. (22)
What is a hiatal hernia (hiatus hernia)? This condition happens when the top of the stomach bulges through an opening in the diaphragm.
What are the signs of a hiatal hernia (hiatus hernia)? The signs of this condition include: acid reflux, indigestion, wind, chest pain, difficulty swallowing or bad breath.
How do you develop a hiatal hernia (hiatus hernia)? The exact cause of this condition is unclear. However, it is prevalent in people over the age of 50 years. Several factors, such as being overweight and genetics, can play a part.
How are you diagnosed for hiatal hernia (hiatus hernia)? A barium x-ray or endoscopic examination with a camera can detect this condition. (23)
What is the best treatment for hiatal hernia (hiatus hernia)? Lifestyle changes and medications are usually sufficient to improve this condition. There might be situations when surgery is required.
What are the long term complications of hiatal hernia (hiatus hernia)? If a herniation is severe, the stomach can twist, causing it to become strangulated. Surgery is required to correct this.
Is hiatal hernia (hiatus hernia) considered a disability? This condition is not considered a disability, however social security benefits might be paid in some instances.
Is there a cure for hiatal hernia (hiatus hernia)? This condition often causes no discomfort. When it does, there are treatments available which are successful in managing the symptoms.
Is a hiatal hernia (hiatus hernia) life threatening? This condition is not considered life threatening.
A hiatal hernia (hiatus hernia) happens when the top of the stomach bulges through an opening in the diaphragm. This common condition causes few or no symptoms in many sufferers, and they may be unaware they have it.
When symptoms are present, there are treatments available to successfully manage them. Fortunately, surgery is rarely required.