Hiatal hernia

Definition

Hiatal hernia is a condition in which part of the stomach sticks upward into the chest, through an opening in the diaphragm. The diaphragm is the sheet of muscle that separates the chest from the abdomen. It is used in breathing.

Alternative Names

Hernia - hiatal

Causes

The cause is unknown, but hiatal hernias may be due to a weakening of the supporting tissue. Increasing age, obesity, and smoking are known risk factors in adults.

Children with this condition are usually born with it (congenital). It often occurs with gastroesophageal reflux in infants.

Hiatal hernias are very common, especially in people over 50 years old. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus.

Symptoms

• Chest pain
• Heartburn, worse when bending over or lying down
• Swallowing difficulty

A hiatal hernia by itself rarely causes symptoms. Pain and discomfort are usually due to the reflux of gastric acid, air, or bile.

Exams and Tests

• Barium swallow x-ray
• Esophagogastroduodenoscopy (EGD)

Treatment

The goals of treatment are to relieve symptoms and prevent complications.

Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) will relieve pain. Medications that neutralize stomach acid, decrease acid production, or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esphagus) may be prescribed.

Other measures to reduce symptoms include:

• Avoiding large or heavy meals
• Not lying down or bending over right after a meal
• Reducing weight and not smoking

If these measures do not control the symptoms, or you have complications, you may need surgery to repair the hernia.

Outlook (Prognosis)

Treatment can relieve most symptoms of hiatal hernia.

Possible Complications

• Pulmonary (lung) aspiration
• Slow bleeding and iron deficiency anemia (due to a large hernia)
• Strangulation (closing off) of the hernia

When to Contact a Medical Professional

Call your health care provider if:

• You have symptoms of a hiatal hernia
• You have a hiatal hernia and your symptoms get worse or do not improve with treatment, or new symptoms develop

Prevention

Controlling risk factors such as obesity may help prevent hiatal hernia.

References

Richter JE, Friedenberg FK. Gastroesophageal reflux disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 43.

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