Hiatal Hernia: Symptoms, Causes, Treatment & Care

This guide explains hiatal hernia symptoms, causes, treatment, and when to seek care. It also covers tests, daily care, medicines, surgery, and possible complications.

Many small sliding hiatal hernias cause no symptoms ^2,7. A test for another health problem may find one.

When symptoms occur, they often involve acid reflux ^2,6. Heartburn and regurgitation are common reflux symptoms ^2,6. Regurgitation can involve stomach acid washing back into the esophagus ^6,7.

Treatment depends on the symptoms and the hernia’s structure ¹. A hiatal hernia without symptoms may need no treatment.

A hiatal hernia occurs when abdominal tissue passes through the diaphragm’s esophageal opening ^1,2. The tissue then moves into the chest cavity ^1,2.

The stomach is involved in most hiatal hernias ¹. Some hernias also contain bowel, spleen, or other abdominal tissue ¹.

The diaphragm is the muscle wall between the chest and abdomen ⁶. It is also the main muscle used for breathing ².

The esophagus passes through an opening in the diaphragm ^6,7. The esophagus is the tube that carries food toward the stomach. Its opening in the diaphragm is called the esophageal hiatus ⁶.

Weakness or widening around the hiatus can let stomach tissue move upward ^6,7. This change often develops slowly over many years ⁶.

Doctors divide hiatal hernias into sliding and paraesophageal groups ^1,8. Four types describe the main changes in their structure ^6,8.

The four types have these key features:

Type I sliding hernias are the most common kind ^1,6. Types II through IV are paraesophageal hernias ¹.

The word “paraesophageal” means beside the esophagus ⁶. These hernias may contain stomach tissue inside a tissue sac ^1,8.

Many small sliding hernias cause no symptoms ^2,7. Testing for another condition may find them.

The gastroesophageal junction is where the esophagus meets the stomach ². A sliding hernia moves this junction above the diaphragm.

The lower esophageal sphincter is a pressure zone near this junction ². It helps keep stomach contents from moving backward ².

The diaphragm also supports the body’s barrier against reflux ². A hiatal hernia can weaken that support and promote reflux ².

Reflux occurs when food or stomach acid enters the esophagus ³. Long-term reflux disease is called gastroesophageal reflux disease, or GERD ³.

A hiatal hernia can make GERD symptoms worse ³. However, not everyone with a hiatal hernia has acid reflux ⁶.

Small sliding hiatal hernias often cause no symptoms ^2,7. Symptomatic cases commonly cause problems linked with acid reflux ^2,6.

Larger paraesophageal hernias may cause swallowing problems or early fullness ^2,6. They may also cause pressure in the upper abdomen ⁶.

Symptoms alone cannot confirm GERD ². Tests can check for a hiatal hernia and related damage ^1,10.

Heartburn is a burning feeling in the chest ⁶. It may be more noticeable after eating ⁶.

Regurgitation brings food, liquid, or acid toward the throat ^6,7. Acid can also irritate the throat and affect the voice ^2,6.

Common reflux symptoms linked with hiatal hernias include:

These symptoms do not confirm that GERD is present ². People with heartburn may have different reflux conditions ².

The esophagus may look normal during an endoscopy despite reflux ². Acid testing may help when the cause remains unclear ².

Large hiatal hernias may produce mechanical symptoms ^2,6. This pressure can cause symptoms beyond heartburn.

Possible symptoms from a larger hernia include:

Trouble swallowing is also called dysphagia. Painful swallowing is called odynophagia.

Serious complications are uncommon, but they can occur ². These include bleeding, obstruction, strangulation, and gastric volvulus ^1,2.

An obstruction blocks the usual passage of food or liquid. Gastric volvulus can occur when the stomach moves entirely into the chest ².

Strangulation may affect blood flow to trapped tissue ⁶. Organ ischemia means an organ has lost needed blood flow ⁶.

Bleeding linked with a hiatal hernia may cause anemia ^1,2. Anemia means the blood cannot carry enough oxygen through the body.

Bleeding, obstruction, and volvulus create a stronger reason for surgical repair ¹. Irreversible organ ischemia also appears in the acute treatment pathway ¹. These complications can be emergencies. Seek emergency care right away for sudden severe chest or upper abdominal pain, repeated vomiting or inability to keep anything down, vomiting blood, or black or bloody stools.

The exact cause of a hiatal hernia is not always clear. Weak tissue and increased abdominal pressure may both play roles ^1,2,7.

Older age and obesity are common risk factors ¹. Pregnancy and chronic constipation are linked with increased abdominal pressure ².

A risk factor raises the chance of a condition. It does not prove a single direct cause.

Hiatal hernias occur more often with increasing age ^1,2. Muscles and connective tissue may lose strength and flexibility over time ².

Connective tissue supports and joins structures inside the body. Age-related tissue changes may allow the hiatus to widen ².

Weak tissue around the esophagus may also contribute ². This weakness can promote a paraesophageal hernia ².

A shortened esophagus may pull the stomach upward ². This feature may be present at birth or follow esophageal inflammation ².

Long-term pressure inside the abdomen is linked with acquired hiatal hernias ^1,2. Several health conditions and activities may raise this pressure ⁶.

Associated factors include the following examples:

These factors are associations rather than proof of one direct cause. Constant and intense pressure is linked with hernia formation.

An injury near the diaphragm can contribute to a hiatal hernia. Some operations may affect tissue near the stomach and esophagus ⁹.

Other possible contributors include:

Congenital means that a feature was present at birth. Hiatal hernias can be congenital, but acquired hernias are more common ².

A hiatal hernia often appears during testing for digestive symptoms. Imaging can show its location and structure ².

Different tests answer different questions. A clinician selects tests based on the symptoms and possible treatment ^1,3.

A clinician may ask about heartburn, regurgitation, swallowing problems, or vomiting ¹. Questions may also cover past operations and known risk factors ¹.

Age, obesity, and previous gastroesophageal surgery are recognized risk factors ¹. Reviewing these factors can support the diagnostic process ¹.

An examination may sometimes find bowel sounds within the chest ¹. Imaging provides more detail about the hernia’s structure ¹.

Symptoms alone cannot confirm GERD ². Testing can help separate reflux disease from other causes of heartburn ².

An upper digestive contrast study is a key hiatal hernia test ¹. It uses X-rays and a swallowed contrast liquid ^1,10.

This test is often called an upper gastrointestinal study. It may also be called a barium swallow.

The liquid coats the upper digestive tract. X-rays then outline the esophagus, stomach, and upper intestine.

This study is listed among the first diagnostic tests ¹. Surgeons may use these details when planning an operation ¹.

Upper endoscopy uses a thin tube with a small camera. The tube passes through the mouth into the esophagus and stomach.

Endoscopy lets the clinician inspect the inner digestive lining. It can check the esophagus for inflammation.

A CT scan may help when the diagnosis remains unclear ¹. It may also provide details for surgical planning ¹.

Other specialized tests may include:

These tests do not serve the same purpose. These tests may help evaluate the esophagus, hiatal hernia, or reflux ^1,3,10.

Hiatal hernia treatment depends on symptoms and anatomy ¹. A hiatal hernia without symptoms often needs no treatment.

Uncomplicated sliding hernias are generally treated by controlling symptoms ¹. Treatment may include lifestyle changes, medicines, or surgery ^4,10.

Lifestyle changes may reduce reflux symptoms ^4,10. These steps focus on meals, body weight, smoking, and sleep position ^4,10.

Helpful lifestyle choices include:

A foam wedge can raise the head and upper back together ⁴. This change places the body on an incline during sleep ⁴.

Food triggers may include fatty foods, alcohol, chocolate, mint, and caffeine. Tomato sauce, garlic, and onions can also trigger symptoms.

Several medicine groups can control acid and reflux symptoms ^4,10. Some are available without a prescription ^4,10.

The main medicine options include:

Antacids may cause diarrhea or constipation ⁴. Overuse of some antacids can also cause kidney problems.

Discuss daily antacid use with a clinician ⁴. Severe symptoms should not rely on daily antacids without medical guidance ⁴.

Proton pump inhibitors are often called PPIs ⁴. Prescription and nonprescription forms are available ^4,10.

Doctors may prescribe PPIs for long-term GERD treatment ⁴. Discuss the risks and benefits of long-term use with a doctor ⁴.

Surgery may help when lifestyle changes and medicines do not control GERD ⁴. It may also treat reflux-related problems such as chronic cough or hoarseness ^3,10.

Reflux-related esophageal damage can include inflammation, ulcers, scarring, narrowing, or bleeding ^3,10. Complicated hiatal hernias have a stronger reason for surgical repair ¹.

These complications include bleeding, obstruction, or gastric volvulus ¹. Larger paraesophageal hernias may also require surgery ².

Hiatal hernia repair can return the stomach to the abdomen. The surgeon may tighten the diaphragm opening with stitches ^3,10.

Fundoplication is the most common operation for reflux ^3,4. The surgeon wraps the upper stomach around the lower esophagus ^3,4.

This wrap raises pressure near the lower esophageal sphincter ^3,4. The added pressure helps keep acid and food from moving backward ^3,4.

A laparoscopic repair uses several small cuts in the abdomen ^3,4. An open repair uses one larger abdominal cut ³.

Surgery has risks that should be discussed before the procedure:

A surgeon can explain the planned procedure and its risks. The treatment plan should match the symptoms and hernia anatomy ¹.

Make a medical appointment when symptoms last or cause concern. Contact a doctor when symptoms continue despite nonprescription medicines ⁴.

Ongoing problems may lead to a discussion of prescription treatment ^4,10. A digestive specialist may assess symptoms that continue after treatment.

Trouble swallowing can occur with a hiatal hernia ³. Lasting or worrying swallowing problems should be medically assessed.

Heartburn that does not improve with nonprescription medicine needs medical review ⁴. Symptoms that remain after treatment may require specialist care.

Bleeding and anemia can occur with a hiatal hernia ^1,2. Bleeding, obstruction, and volvulus create stronger reasons for surgery ¹.

Useful reasons to contact a healthcare professional include:

Preparing notes may help organize the visit. Mayo Clinic advises writing down all symptoms before an appointment.

Useful information to prepare includes:

A clinician may provide special instructions before a procedure. Follow the instructions given for the planned test.

Understanding hiatal hernia symptoms, causes, treatment, and when to seek care supports informed health choices. Many small sliding hiatal hernias cause no symptoms ^2,7.

Symptomatic sliding hernias are often managed by treating reflux ¹. Lifestyle changes and acid-reducing medicines are common treatment options ^4,10.

Surgery may help with resistant reflux or serious esophageal damage ^3,4,10. Complicated hernias have a stronger reason for surgical repair ¹.

Bleeding, obstruction, volvulus, strangulation, and organ ischemia are serious complications ^1,2. Lasting or worrying symptoms should be discussed with a healthcare professional.