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Hiatal hernia

Hernia - hiatal

Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest. The diaphragm is the sheet of muscle that divides the chest from the abdomen.

Causes

The exact cause of hiatal hernia is not known. The condition may be due to weakness of the supporting tissue. Your risk for the problem goes up with age, obesity, and smoking. Hiatal hernias are very common. The problem occurs often in people over 50 years.

This condition may be linked to reflux (backflow) of gastric acid from the stomach into the esophagus.

Children with this condition are most often born with it (congenital). It often occurs with gastroesophageal reflux in infants.

Symptoms

Symptoms may include:

  • Chest pain
  • Heartburn, worse when bending over or lying down
  • Swallowing difficulty

A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are due to the upward flow of stomach acid, air, or bile.

Exams and Tests

Tests that may be used include:

Treatment

The goals of treatment are to relieve symptoms and prevent complications. Treatments may include:

Other measures to reduce symptoms include:

  • Avoiding large or heavy meals
  • Not lying down or bending over right after a meal
  • Reducing weight and not smoking
  • Raising the head of the bed 4 to 6 inches (10 to 15 centimeters)

If medicines and lifestyle measures do not help control symptoms, you may need surgery.

Outlook (Prognosis)

Treatment can relieve most symptoms of hiatal hernia.

Possible Complications

Complications may include:

  • Pulmonary (lung) aspiration
  • Slow bleeding and iron deficiency anemia (due to a large hernia)
  • Strangulation (closing off) of the hernia

When to Contact a Medical Professional

Call your health care provider if:

  • You have symptoms of a hiatal hernia.
  • You have a hiatal hernia and your symptoms get worse or do not improve with treatment.
  • You develop new symptoms.

Prevention

Controlling risk factors such as obesity may help prevent hiatal hernia.

References

Brady MF. Hiatal hernia. In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019:663.e2-663.e5.

Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.

Rosemurgy AS. Paraesophageal hernia. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:1534-1538.

Yates RB, Oelschlager BK, Pellegrini CA. Gastroesophageal reflux disease and hiatal hernia. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 42.

Text only

  • Hiatal hernia - X-ray

    Hiatal hernia - X-ray - illustration

    This X-ray shows the upper portion of the stomach protruding through the diaphragm (hiatal hernia).

    Hiatal hernia - X-ray

    illustration

  • Hiatal hernia

    Hiatal hernia - illustration

    A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.

    Hiatal hernia

    illustration

  • Hiatal hernia repair - series

    Hiatal hernia repair - series

    Presentation

    • Hiatal hernia - X-ray

      Hiatal hernia - X-ray - illustration

      This X-ray shows the upper portion of the stomach protruding through the diaphragm (hiatal hernia).

      Hiatal hernia - X-ray

      illustration

    • Hiatal hernia

      Hiatal hernia - illustration

      A hiatal hernia occurs when part of the stomach protrudes up into the chest through the sheet of muscle called the diaphragm. This may result from a weakening of the surrounding tissues and may be aggravated by obesity and/or smoking.

      Hiatal hernia

      illustration

    • Hiatal hernia repair - series

      Presentation

     

    Review Date: 3/26/2019

    Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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