Hiatal Hernias

A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm into the chest. Small hernias may contribute heartburn or cause no symptoms. Larger hernias, known as paraesophageal hernias, may cause difficulty swallowing and chest pain. Larger hernias may even turn into surgical emergencies.

About Hiatal Hernias

The diaphragm helps with breathing and keeps the stomach in place. When the muscle around the hiatus weakens, part of the stomach can slip upward into the chest.

Types of Hiatal Hernias:

• Small hiatal hernias: Often do not cause symptoms and may not require treatment.
• Larger hiatal hernias (greater than 5 cm): Can cause complications and sometimes require surgery. Surgery is the only way to repair a hiatal hernia.

Causes of Hiatal Hernias

Hiatal hernias may be linked to:

• Age-related changes in the diaphragm
• Being born with a large hiatus
• Injury or prior surgery to the area
• Increased pressure on the abdomen from:
  • Persistent coughing
  • Heavy lifting or straining
  • Vomiting
  • Straining during bowel movements

Symptoms of Hiatal Hernias

Small hiatal hernias can contribute to heartburn or acid reflux, or they may cause no symptoms at all.

Larger hiatal hernias may cause:

• Heartburn or acid reflux
• Chest or abdominal pain
• Difficulty swallowing (dysphagia)
• Regurgitation of food or liquid
• Feeling full quickly after eating
• Indigestion
• Dry cough or shortness of breath
• Tooth decay from acid exposure
• Vomiting blood or passing black stools (a sign of gastrointestinal bleeding)

Risk Factors for Hiatal Hernias

Hiatal hernias are more common in people over the age of 50 but can occur at any age.

Other risk factors include:

• Obesity
• Pregnancy
• Smoking

Diagnosing Hiatal Hernias

Doctors confirm hiatal hernias using imaging tests:

• Barium swallow (esophagogram): You drink a chalky liquid that coats your upper digestive tract, making it visible on X-ray.
• Upper endoscopy: A thin, flexible tube with a camera is guided down the throat to examine the esophagus and stomach.

Treating Hiatal Hernias

Treatment depends on the size of the hernia and your symptoms:

• Small hernias: Often managed with lifestyle changes (e.g., avoiding large meals, elevating the head while sleeping, losing weight) and medications to reduce acid reflux.
• Large hernias: May require surgery, usually performed laparoscopically (through several small incisions). Specialists in digestive health and foregut conditions often achieve the best outcomes.