Hiatal HerniaA hiatal hernia occurs when the upper part of your stomach pushes up through your diaphragm and into your chest region. It enters via an opening (called the hiatus) where the esophagus passes on its way to the stomach. Hiatal hernias don’t always cause symptoms. In some cases, they may be associated with heartburn, acid reflux, and chest pain.
Hiatal hernias may not require any treatment. Some are treated with medications and a few types need surgical repair. However, patients who do experience symptoms will have a higher risk for more severe complications and should receive care promptly.
Types of Hiatal Hernia
There are generally two types of hiatal hernias: sliding hiatal hernias and paraesophageal hernias.
Sliding hiatal hernia
This is the more common type of hiatal hernia. It occurs when your stomach and the lower part of your esophagus slide up into your chest through the diaphragm. Sliding hernias tend to be small. They usually don’t cause any symptoms, and may not require treatment.
This type of hernia is not as common and considered more serious. Your esophagus and stomach stay where they should be, but part of your stomach squeezes through the hiatus to sit next to your esophagus. Rarely, your stomach can become squeezed and lose its blood supply causing a serious medical emergency.
Hiatal Hernia Causes
The most common causes of hiatal hernias are muscle weakness and an increase in pressure in the abdominal cavity. However, other conditions, traits or habits may also play a role in increasing your risk including:
- Older age
- Long history of cigarette smoking and/or drug abuse
- Damage from an injury or surgery
- Being born with an unusually large hiatus
- Family history/Genetics
- Persistent pressure on the surrounding muscles, while coughing, repeatedly vomiting, straining during a bowel movement, or lifting heavy objects
Hiatal Hernia Symptoms
It’s rare for hiatal hernias to cause symptoms. If you do experience any pain and discomfort they’re usually caused by the upward flow of stomach acid, bile, or air. Common symptoms include:
- Chest pain
- Heartburn, worse when bending over or lying down
- Swallowing difficulty
- Acid reflux or GERD
Seek medical treatment immediately, if you have any of the following symptoms:
- Severe pain in your chest or belly
- A persistent upset stomach
- Unable to have a bowel movement or pass gas
These could be signs of a strangulated hernia or an obstruction, which are medical emergencies.
Hiatal Hernia Diagnosis
Several tests can be done to help diagnose a hiatal hernia. A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. These tests or procedures include:
- X-rays (barium swallow test)
- CT scan
- Esophageal manometry test
- Gastric emptying studies
Hiatal Hernia Lifestyle and Medication Treatments
Some people do not experience any symptoms related to their hiatal hernia. If you only experience mild symptoms, like heartburn, then your provider will likely only recommend medication and lifestyle changes such as:
- Healthy diet
- Avoiding bending over or lying down after eating
- Sleeping in a slightly elevated position
- Smoking cessation
- Over-the-counter antacids or antihistamines
- Proton pump inhibitors or H2-receptor blockers to lower acid production
Hiatal Hernia Surgical Treatments
Sometimes a hiatal hernia requires an operation for repair. This is usually performed using minimally invasive techniques, known as laparoscopic or robotic surgery. Your surgeon inserts a camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor. These “minimally invasive” procedures have smaller cuts, less risk of infection, minimal pain and scarring, and faster recovery than traditional surgeries.
Gastroesophageal Reflux and Motility Program
JFK University Medical Center
65 James Street, Edison, NJ 08820
To find a Hackensack Meridian Health physician near you who treats Reflux Disease, please call 855-HMH-WELL.
Gastroenterologists treat a comprehensive range of digestive diseases with innovative diagnostic methods and medical treatments. If you have made lifestyle changes, altered your diet appropriately, and still are suffering with GERD symptoms, it may be time to consult with a surgeon.
Why Choose HMH Gastroenterology
Our gastroenterologists are the only physicians in New Jersey to perform a highly specialized procedure to treat pancreas tumors and cysts. They also participate in clinical trials that bring the most promising new treatments and therapies to patients in the New York-New Jersey metropolitan area.