Hiatus hernia

Overview

A hiatus hernia is when part of your stomach pushes up through your diaphragm (the muscle that separates your chest from your tummy) into your chest cavity. It is a common condition that often causes no symptoms, but can lead to acid reflux.

Yes, hiatus hernias are very common, especially in people over 50. Many people have one and never experience any problems.

Anyone can develop a hiatus hernia, but it is more common in older adults, people who are overweight or obese, and those who smoke. It also can occur in pregnant women.

Symptoms

Common symptoms

• Heartburn (a burning feeling in the chest or throat)
• Regurgitation (stomach acid or food coming back up into the mouth)
• A feeling of fullness or pressure in the upper belly
• Difficulty swallowing (dysphagia)
• Belching or hiccupping that doesn't go away

Symptoms in children

• In children, symptoms can include vomiting, feeding difficulties, and poor weight gain.

Symptoms in older adults

• Symptoms may be milder, such as heartburn after meals or when lying down, and occasional regurgitation.

Causes

Main causes

• The diaphragm muscle weakens with age, allowing part of the stomach to slip through.
• Increased pressure in the abdomen pushes the stomach upward, such as from obesity, heavy lifting, or pregnancy.
• Injury to the diaphragm or previous surgery in the area can cause a hernia.

Risk factors

• Being overweight or obese
• Being over 50 years old
• Smoking
• Frequent heavy lifting or straining during bowel movements
• Chronic coughing or vomiting

When to see a doctor

See a doctor urgently if:

• If you have severe chest pain or trouble breathing, call your local emergency number immediately.
• If you vomit blood or have black stools, see a doctor right away.

Book a routine appointment if:

• If you have frequent heartburn (several times a week) that isn't relieved by lifestyle changes or over-the-counter treatments.
• If you have trouble swallowing or feel like food gets stuck in your chest.
• If you have persistent belching, hiccups, or a feeling of fullness after eating.

Diagnosis

A hiatus hernia is often found when you are being checked for other issues, like heartburn or indigestion. Your doctor will ask about your symptoms and may perform some tests to confirm the diagnosis.

Tests that may be done

• Endoscopy: A thin, flexible tube with a camera is passed down your throat to look at your esophagus, stomach, and the opening in your diaphragm.
• Barium swallow: You drink a chalky liquid that shows up on X-rays, and pictures are taken as it moves through your digestive system.
• Manometry: A test that measures the pressure in your esophagus to see how well it is working.

What to expect at your appointment

Most tests are done as an outpatient (you go home the same day). Endoscopy is usually done with a light sedative, so you feel relaxed and may not remember much. The tests are not painful but can cause some discomfort like gagging or bloating.

Treatment

Treatment for a hiatus hernia focuses on relieving symptoms, especially acid reflux and heartburn. Many people do not need any treatment if they have no symptoms. If symptoms are present, lifestyle changes and medications are usually tried first.

Self-care at home

• Eat smaller, more frequent meals instead of large ones.
• Avoid foods that trigger heartburn, such as spicy, fatty, or acidic foods (like tomatoes and citrus).
• Don't lie down for at least 2-3 hours after eating.
• Elevate the head of your bed by about 6-8 inches (using blocks or a wedge pillow) to prevent acid from coming up at night.
• Maintain a healthy weight and avoid tight belts or clothing around your waist.

Medical treatments

Your doctor may recommend medicines that reduce stomach acid or neutralize it. These include antacids, acid reducers, and proton pump inhibitors. These are available over-the-counter or by prescription. Always follow your doctor's advice on which one is right for you.

When is surgery considered?

Surgery is rarely needed, but it may be considered if medications don't work, if you have severe complications like a strangulated hernia (where the blood supply is cut off), or if the hernia is very large. The most common procedure is called a fundoplication, where the top of the stomach is wrapped around the lower esophagus to strengthen the barrier.

Living with this condition

Living with a hiatus hernia is usually manageable with simple lifestyle changes. Many people have no symptoms and don't need to do anything special. If you do have symptoms, keeping a food diary can help identify triggers.

Lifestyle tips

• Eat slowly and chew your food well.
• Avoid eating late at night or right before bed.
• Stop smoking, as it weakens the diaphragm and increases acid production.
• Limit alcohol and caffeine, which can relax the valve between the esophagus and stomach.

Diet and exercise

A balanced diet is important. Avoid heavy, greasy, or spicy meals. Gentle exercise like walking can help with weight management and digestion. Avoid exercises that put pressure on your abdomen, like heavy lifting or sit-ups, especially after meals.

Mental health and emotional wellbeing

Chronic heartburn or discomfort can be stressful and affect your quality of life. It may cause anxiety about eating or sleeping. Talk to your doctor if you feel down or worried – they can offer support and treatment options.

Prevention

While you cannot always prevent a hiatus hernia, you can reduce your risk by maintaining a healthy weight, avoiding heavy lifting when possible, eating a balanced diet, and not smoking. These habits also help manage symptoms if you already have a hernia.

Vaccines

There are no vaccines to prevent hiatus hernia.

Screening programmes

There is no routine screening for hiatus hernia. It is usually found when you have tests for other reasons or if you have symptoms.

Complications

If left untreated

• Chronic acid reflux (gastroesophageal reflux disease or GERD) that can damage the esophagus over time.
• Esophagitis (inflammation of the esophagus), which can cause pain and bleeding.
• Narrowing of the esophagus from scar tissue, making swallowing difficult.
• In rare cases, the hernia can become strangulated (blood supply cut off), which is a medical emergency.

Long-term outlook

Most people with a hiatus hernia have no major problems and can manage their symptoms well with lifestyle changes and medicines. Even if complications occur, they can often be treated effectively. With proper care, you can live a full, active life.

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