A hiatal hernia occurs when part of the stomach pushes upward through an opening in the diaphragm into the chest. It is a common condition and is often found incidentally during imaging or endoscopy. Many people have no symptoms, while others may experience reflux-related symptoms such as heartburn, regurgitation, or chest discomfort. Treatment depends on symptoms and severity and may range from lifestyle changes and medications to, in select cases, surgical repair.

What is Hiatal Hernia?

A hiatal hernia occurs when part of the stomach moves upward into the chest through an opening in the diaphragm called the hiatus. The diaphragm is the muscular wall that separates the chest cavity from the abdomen and plays an important role in breathing.

Hiatal hernias are common and often discovered incidentally on imaging or endoscopy. Many people with a hiatal hernia also experience heartburn or acid reflux, although the presence of a hernia does not necessarily cause reflux, and the two conditions can occur independently.

What Causes A Hiatal Hernia To Form?

In many cases, the exact cause of a hiatal hernia is not clear. Factors that may contribute include:

• Age-related weakening of the diaphragm and supporting tissues
• Increased abdominal pressure from chronic coughing, straining during bowel movements, heavy lifting, pregnancy, or significant weight gain
• Injury or trauma to the diaphragm
• Congenital factors, such as being born with a larger-than-normal hiatus
• Conditions associated with increased pressure within the stomach or abdomen

Signs and Symptoms of a Hiatal Hernia

Many small hiatal hernias cause no symptoms at all. Larger hernias may be associated with:

• Heartburn or acid reflux
• Feeling full quickly during meals
• Bloating or discomfort after eating
• Nausea
• Regurgitation of food or liquids
• Difficulty swallowing
• Chest or upper abdominal pain
• Shortness of breath

Less commonly, complications may include:

• Vomiting blood or black stools (a sign of gastrointestinal bleeding)
• Iron-deficiency anemia

How is Hiatal Hernia Diagnosed?

Diagnosis may involve one or more tests, depending on symptoms:

• Barium swallow (upper GI series): A specialized X-ray study that provides detailed information about the size and type of hernia and is particularly useful for distinguishing sliding from paraesophageal hernias
• Upper endoscopy: Allows direct visualization of the esophagus and stomach and can identify associated inflammation or complications
• Esophageal manometry: A pressure study sometimes used when surgical planning is being considered

How Do You Treat A Hiatal Hernia?

If you have no symptoms or only mild symptoms, no treatment may be necessary.

Lifestyle modifications are often effective for reflux-related symptoms and may include:

• Weight loss when appropriate
• Avoiding trigger foods
• Eating smaller meals
• Elevating the head of the bed
• Avoiding lying down soon after eating

Medications may be used to control acid reflux, including:

• Proton pump inhibitors (PPIs)
• H2-receptor blockers
• Antacids for occasional symptoms

Surgery may be recommended in select situations, such as:

• Large hiatal hernias
• Persistent symptoms despite medical therapy
• Preference to avoid long-term medication use
• Significant regurgitation or difficulty swallowing
• Complications such as bleeding or anemia
• Hernia incarceration or strangulation (an emergency)

Hiatal hernias are common and generally benign. Many people never develop symptoms, while others experience reflux-related discomfort that can usually be managed with lifestyle changes and medication. With careful evaluation and individualized treatment, symptoms can often be effectively controlled and complications prevented.