Hiatus Hernia Explained: Causes, Symptoms, Diagnosis and Modern Treatment Options

A hiatus hernia is a common digestive condition that occurs when part of the stomach pushes upwards through an opening in the diaphragm into the chest. Many people have a hiatus hernia without knowing it because it may not cause symptoms. However, in some cases, it can lead to uncomfortable problems such as acid reflux, heartburn and difficulty swallowing.

Understanding the causes, symptoms and treatment options can help people manage the condition effectively and prevent complications.

What Is a Hiatus Hernia?

According to Dr Neeraj Dhamija, Senior Consultant - Laparoscopic, Laser & General Surgery at Sir Ganga Ram Hospital, New Delhi, “The diaphragm is a large muscle that separates the chest from the abdomen and helps with breathing. It has a small opening called the hiatus, through which the food pipe (oesophagus) passes before connecting to the stomach.”

 

 

 

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A hiatus hernia occurs when the upper part of the stomach moves through this opening and enters the chest area.

There are two main types of hiatus hernia:

Sliding Hiatus Hernia

A sliding hiatus hernia is the most common type. It occurs when the stomach and the junction between the stomach and oesophagus move upwards through the diaphragm.

This type is often linked with acid reflux because the valve between the stomach and oesophagus may not work properly.

Para-Oesophageal Hiatus Hernia

A para-oesophageal hiatus hernia is less common but can sometimes be more serious. In this condition, part of the stomach pushes through the diaphragm while the connection between the stomach and oesophagus remains in place.

In some cases, the stomach can become trapped, reducing its blood supply and requiring urgent medical attention.

What Causes a Hiatus Hernia?

According to a study published in the journal 'Surgical Endoscopy', a hiatal hernia develops when the muscles around the diaphragm become weak or when increased pressure pushes the stomach upwards.

Common causes and risk factors include:

• Age-related weakening of the diaphragm muscles
• Increased pressure inside the abdomen
• Obesity
• Pregnancy
• Heavy lifting or straining
• Long-term coughing
• Chronic constipation and repeated straining during bowel movements
• Previous injury or surgery affecting the diaphragm
• Genetic weakness in the diaphragm

NOTE: Hiatus hernias are more common in people over the age of 50, although they can occur at any age.

Symptoms of Hiatus Hernia

Many people with a hiatus hernia do not experience symptoms. When symptoms occur, they are often related to acid reflux.

Common symptoms include:

• Heartburn, especially after meals or when lying down
• Acid or food coming back into the mouth
• Chest discomfort
• Difficulty swallowing
• Feeling full quickly after eating
• Frequent burping
• Bloating
• Nausea
• Persistent cough
• Hoarse voice or throat irritation

Chest discomfort caused by a hiatus hernia can sometimes feel similar to heart-related pain. Any new or severe chest pain should be assessed by a doctor.

How Does a Hiatus Hernia Cause Acid Reflux?

The lower oesophageal sphincter is a muscle that acts like a valve between the oesophagus and stomach. It normally prevents stomach acid from moving back into the food pipe.

According to a study published in the journal 'Medicine', when a hiatus hernia occurs, this valve may become weakened or displaced. As a result, stomach acid can flow upwards, causing gastro-oesophageal reflux disease (GORD).

Repeated exposure to stomach acid can irritate the lining of the oesophagus and cause ongoing symptoms.

How Is a Hiatus Hernia Diagnosed?

Doctors usually diagnose a hiatus hernia based on symptoms and medical history. However, several tests may be used to confirm the diagnosis.

Endoscopy

“An endoscopy uses a thin flexible tube with a camera to examine the oesophagus and stomach. It can detect inflammation, ulcers or other problems caused by acid reflux,” shares Dr Dhamija.

Barium Swallow Test

During this test, the patient drinks a liquid containing barium, which allows doctors to see the oesophagus and stomach on X-rays.

Oesophageal Manometry

This test measures the movement and pressure inside the oesophagus. It helps assess how well the muscles and valve are working.

Treatment Options for Hiatus Hernia

Treatment depends on the severity of symptoms. Many people can manage a hiatus hernia through lifestyle changes and medicines.

Lifestyle Changes to Reduce Symptoms

Simple changes can often improve symptoms significantly. These include:

• Eating smaller meals more frequently
• Avoiding lying down immediately after eating
• Maintaining a healthy weight
• Avoiding foods that trigger reflux symptoms
• Reducing spicy, fatty and acidic foods if they worsen symptoms
• Limiting caffeine and alcohol
• Stopping smoking
• Raising the head of the bed if symptoms occur at night

Medicines for Hiatus Hernia

Doctors may recommend medicines that reduce stomach acid and relieve reflux symptoms. Common options include:

• Antacids for quick relief of occasional heartburn
• H2 receptor blockers that reduce acid production
• Proton pump inhibitors (PPIs) that provide stronger acid suppression

NOTE: Medicines should be taken as advised by a healthcare professional, especially if symptoms continue for a long period.

When Is Surgery Needed for Hiatus Hernia?

Most people with a hiatus hernia do not need surgery. However, an operation may be recommended if:

• Symptoms are severe and do not improve with medicines
• There are complications such as bleeding or narrowing of the oesophagus
• A large para-oesophageal hernia is present
• The stomach becomes trapped or loses its blood supply

A report published in the journal ‘Sages’ explains surgical procedures for hiatal hernia treatment.

Hiatus hernia surgery usually involves moving the stomach back into its correct position and strengthening the diaphragm opening. It may also include a procedure called fundoplication, which improves the barrier between the stomach and oesophagus to reduce reflux.

Modern keyhole surgery techniques usually allow faster recovery and smaller scars compared with traditional open surgery.

Possible Complications of Hiatus Hernia

A study published in the Cureus Journal of Medical Science mentions that while many hiatus hernias are harmless, untreated severe cases can sometimes lead to complications, including:

• Chronic acid reflux
• Inflammation of the oesophagus (oesophagitis)
• Difficulty swallowing
• Bleeding from irritation or ulcers
• Anaemia due to long-term bleeding
• Narrowing of the oesophagus
• Stomach trapping in para-oesophageal hernia

Regular medical advice is important if symptoms are persistent or worsening.

Can a Hiatus Hernia Be Prevented?

According to Dr Dhamija, “Hiatus hernia cannot always be prevented, especially when it develops due to age-related changes or natural weakness in the diaphragm.”

However, certain habits may reduce the risk and control symptoms including:

• Maintaining a healthy weight
• Eating a balanced diet
• Exercising regularly
• Avoiding heavy lifting without proper technique
• Treating chronic cough
• Preventing constipation
• Avoiding smoking

When To See a Doctor?

You should seek medical advice if you have:

• Persistent heartburn
• Difficulty swallowing
• Unexplained weight loss
• Vomiting
• Blood in vomit or stools
• Severe chest or abdominal pain
• Symptoms that do not improve with lifestyle changes

Early assessment helps identify the cause of symptoms and ensures appropriate treatment.

Final Word

A hiatus hernia is a common condition where part of the stomach moves through the diaphragm into the chest. While many people have no symptoms, others may experience acid reflux, heartburn, and swallowing difficulties. Lifestyle changes and medicines can often control symptoms, while surgery may be required in severe cases. Understanding the signs and seeking timely medical advice can help prevent complications and improve quality of life.