A hiatal hernia occurs when the upper part of the stomach pushes upward through the diaphragm into the chest.

Normally, the esophagus passes down through the chest, crosses the diaphragm and enters the abdomen through a hole in the diaphragm called the esophageal hiatus. Just below the diaphragm, the esophagus joins the stomach. In individuals with hiatal hernias, the opening of the esophageal hiatus is larger than normal, which allows a portion of the upper stomach to protrude through the hiatus and into the chest.

The two main types of hiatal hernias are:

  • Sliding hiatal hernias: This is the most common type of hiatal hernia, in which part of the stomach slides into and out of the chest cavity. This may occur because of weakening of the anchors of the esophagus to the diaphragm, from years of longitudinal esophageal muscle contractions or from increased pressure in the abdomen.
  • Paraesophageal hernias: This occurs when part of the stomach squeezes through the hiatus, placing it next to the esophagus. Unlike sliding hernias, paraesophageal hernias remain in the chest at all times. This type of hernia is less common, but can be dangerous because the stomach may become “strangled” which means its blood supply is cut off.

Risk factors for hiatal hernias

Hiatal hernias are more common in adults over 50 years of age.

Other factors that increase your chance of getting hiatal hernia include:

  • Obesity
  • Abdominal injury or sudden physical exertion (such as weight lifting)
  • Regular increased pressure in the abdomen from activities like severe coughing, vomiting and straining during bowel movements

Symptoms of hiatal hernias

Most people with hiatal hernias have no symptoms. However, a hiatal hernia can lead to stomach acid moving up into the esophagus. This is known as gastroesophageal reflux disease (GERD).

Symptoms of GERD can include:

  • Heartburn, especially after eating or lying down
  • Dysphagia (difficulty swallowing)
  • Pain or discomfort in the stomach, chest, or esophagus
  • Belching
  • Hoarseness
  • Frequent clearing of the throat from irritation
  • Chest pain

Because hiatal hernia symptoms are similar to many other esophageal conditions, accurate evaluation is critical to ensure proper treatment. That is why it is important to seek care from a health care expert experienced in the complex diagnosis and treatment of esophageal disorders and other related conditions.



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