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Hiatus hernia: Symptoms, diagnosis, treatment and prevention

A hiatus hernia happens when part of the stomach squeezes through an opening in the diaphragm, called the hiatus, and into the chest.  This is also known as a hiatal hernia.

Hiatus hernia is thought to affect around a third of over 50s at some stage. Hiatus hernia is also more common in women, smokers, and people who are overweight.

A hiatus hernia may not cause any symptoms, but it can cause gastro-oesophageal reflux disease or GORD.

hiatus hernia graphic

There are two main types of hiatus hernia. The most common is sliding hiatus hernia where the hernia moves in and out of the chest.

Less common is the para-oesophageal hiatus hernia or rolling hiatus hernia. Here, part of the stomach goes through the hole in the diaphragm next to the oesophagus.

What causes a hiatus hernia?

It's not always known what causes a hiatus hernia, but a weakening of the diaphragm with age may be responsible. In other cases, pressure on the abdomen may be to blame.

Hiatus hernia is also possible in newborn babies if their diaphragm hasn't developed properly.

How is a hiatus hernia diagnosed?

A hiatus hernia can be diagnosed with endoscopy, where a camera on the end of a tube is inserted through the mouth and down into the stomach.

Another method is the barium meal X-ray, where a special chemical is drunk and then x-rays are taken to give a clear image of the hernia.

How are hiatus hernias treated?

Treatment is only needed if the hiatus hernia is causing problems.

Lifestyle changes or medicine may be recommended for the symptoms of GORD.

If these haven’t worked, keyhole surgery may be recommended for sliding hiatus hernia.

The surgical procedures available are:

  • Laparoscopic nissen fundoplication (LNF) to put the stomach back into its correct position and to tighten the diaphragm.
  • Para-oesophageal hiatus hernia may be needed to reduce the risk of the hernia becoming strangulated.

When should I seek medical advice about a hiatus hernia?

If you have been diagnosed with a hiatus hernia and you develop severe pain in the chest or abdomen, become nauseated, are vomiting or are unable to have a bowel movement or pass wind, you may have a strangulated hernia or an obstruction, which are medical emergencies. Seek medical advice urgently.

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WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on December 30, 2013

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