Hiatus hernia: Symptoms, diagnosis, treatment and prevention

Any time an internal body part pushes into an area where it doesn't belong, it's called a hernia.

The hiatus is an opening in the diaphragm - the muscular wall separating the chest cavity from the abdomen. Normally the oesophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatus hernia (also called hiatal hernia) the stomach bulges up into the chest through that opening.

There are two main types of hiatus hernias: sliding and rolling, or “para-oesophageal” (next to the oesophagus).

In a sliding hiatus hernia the stomach and the section of the oesophagus that joins the stomach slide up into the chest through the hiatus. This is the more common type of hernia.

The rolling hiatus hernia is less common, but is more cause for concern. The oesophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, landing it next to the oesophagus. Although you can have this type of hernia without any symptoms, the danger is that the stomach can become "strangled", or have its blood supply cut off.

Often people with hiatus hernia also have heartburn or GORD. Although there appears to be a link, one condition does not seem to cause the other, because many people have a hiatus hernia without having GORD, and others have GORD without having a hiatus hernia.

People with a hiatus hernia may experience chest pain that can easily be confused with the pain of a heart attack. That's why it's so important to undergo testing and get properly diagnosed.

What causes a hiatus hernia?

Most of the time the cause is not known. Some people develop a hiatus hernia after sustaining an injury to that area of the body; others are born with a weakness or an especially large hiatus. Some experts suspect that increased pressure in the abdomen from coughing, straining during bowel movements, pregnancy and delivery, or substantial weight gain may contribute to the development of a hiatus hernia.

Who is at risk of hiatus hernia?

In addition to the increased occurrence in people over 50 years old, hiatus hernias also occur more often in overweight people (especially women) and smokers.

How is a hiatus hernia diagnosed?

A hiatus hernia can be diagnosed with a specialised X-ray study that allows visualisation of the oesophagus (barium swallow) or with endoscopy.

How are hiatus hernias treated?

Most people do not experience any symptoms of their hiatus hernia so no treatment is necessary. However the rolling hiatus hernia (when part of the stomach squeezes through the hiatus) can cause the stomach to be strangled so surgery is usually recommended. Other symptoms that may occur along with the hernia such as chest pain should be properly evaluated. Symptoms of GORD should be treated.