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Hiatal Hernia

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest, often causing heartburn, regurgitation, and reflux symptoms, especially after age 50.

Gastrointestinal
A hiatal hernia occurs when the upper part of the stomach pushes up through the hiatus — the opening in the diaphragm that the esophagus passes through — into the chest. Small "sliding" hiatal hernias are very common, especially after age 50, and many cause no problems at all. Larger hernias, including the less common paraesophageal type, can cause persistent reflux symptoms and occasionally require surgical repair. Doctors describe the two types simply: in a sliding hernia the junction of the esophagus and stomach glides up into the chest, while in a paraesophageal hernia part of the stomach squeezes up alongside the esophagus. Causes: A hiatal hernia develops when the muscle tissue around the hiatus weakens or the opening enlarges. Contributing factors include:
  • Age-related changes: The diaphragm and its supporting tissues naturally lose elasticity over time.
  • Increased pressure in the abdomen: Obesity, pregnancy, chronic coughing, repeated heavy lifting, and straining with constipation all push the stomach upward.
  • Injury or surgery: Trauma to the area or prior operations can weaken the hiatus.
  • Being born with a larger hiatus: Some people simply have a wider opening from birth.
Symptoms: Many hiatal hernias — particularly small ones — cause no symptoms and are found incidentally on imaging or endoscopy. When symptoms occur, they are usually those of acid reflux, because the hernia weakens the natural valve between the esophagus and stomach:
  • Heartburn: Burning discomfort behind the breastbone, often worse after meals or when lying down; frequent heartburn overlaps with gastroesophageal reflux disease (GERD).
  • Regurgitation: Sour fluid or food coming back up into the throat or mouth.
  • Throat symptoms: Hoarseness, throat clearing, or a lump-in-the-throat feeling, as seen in laryngopharyngeal reflux.
  • Difficulty swallowing or early fullness: More common with larger hernias.
  • Chest or upper abdominal discomfort: A large paraesophageal hernia can cause pressure-like pain after eating.
Symptoms often wax and wane with weight changes, meal size, and posture, and many hiatal hernias never need treatment at all when they cause no symptoms. Diagnosis: A hiatal hernia may be identified on a barium swallow X-ray, an upper endoscopy, or a CT scan done for another reason. Endoscopy has the advantage of directly examining the esophagus and stomach lining, checking for irritation, gastritis, or ulcers. Esophageal manometry and pH testing are sometimes used when surgery is being considered or symptoms are hard to explain. Treatment: Treatment targets symptoms, not the hernia's mere presence.
  • Lifestyle measures: Smaller meals, avoiding food within three hours of bedtime, elevating the head of the bed, limiting trigger foods, losing excess weight, and stopping smoking.
  • Acid-reducing medications: Proton pump inhibitors such as omeprazole, esomeprazole, or pantoprazole are the most effective medicines for reflux symptoms; H2 blockers such as famotidine help milder cases.
  • Surgery: Reserved for large paraesophageal hernias or reflux that persists despite optimal medical therapy. Repair typically involves pulling the stomach back into the abdomen, tightening the hiatus, and often a fundoplication to reinforce the valve.
When to Seek Immediate Care: Sudden severe chest or upper abdominal pain, retching without being able to vomit, or inability to swallow can signal a strangulated paraesophageal hernia and is an emergency. Remember also that chest pain should never be attributed to a hernia until heart problems have been ruled out — call 911 for new or unexplained chest pain. Most people with a hiatal hernia do well with simple measures and, when needed, acid-suppressing medication. The internal-medicine team at Zimmer Medical Group can evaluate your symptoms and tailor a long-term reflux plan, including whether an endoscopy or a surgical opinion makes sense for you.

Related Medications

Commonly prescribed medications for this condition

OmeprazoleEsomeprazolePantoprazole

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