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Hiatal Hernia

Overview, Causes, & Risk Factors

Hiatal hernia is a condition in which the upper part of the stomach moves into the chest through a hole in the diaphragm. The diaphragm is the muscle that divides the chest cavity from the abdomen.

What is going on in the body?

The esophagus is the tube that carries food from the mouth to the stomach. It enters the abdominal cavity through a hole in the diaphragm called the esophageal hiatus. When a person has hiatal hernia, the esophageal hiatus is usually weakened or larger than usual. At times, the upper part of the stomach can pass up through this larger-than-usual hole and into the diaphragm.

What are the causes and risks of the condition?

A hiatal hernia may be caused by:

constant, harsh coughing

vomiting

constipation and straining during bowel movements

sudden physical exertion

pregnancy

obesity

smoking

tight clothing around the abdomen

trauma, causing a hole or tear in the diaphragm

congenital abnormality, or weakness of the esophageal hiatus present at birth

esophageal cancer

medical procedures affecting the esophagus or diaphragm

Symptoms & Signs

What are the signs and symptoms of the condition?

A person with a hiatal hernia often has no symptoms, and the hernia may be found only during a test called an upper GI series. When symptoms do occur they can include:

heartburn

painful swallowing

burping

feeling like food is stuck in the throat

feeling of fullness in the chest

chest pain

blood in the stools

severe pain from constriction of the stomach or esophagus

Diagnosis & Tests

How is the condition diagnosed?

After a complete history and physical, the healthcare provider may order:

ultrasound, a test that uses sound waves to see the diaphragm and stomach

endoscopy, a procedure that uses a long tube to look inside the esophagus

an upper GI series. In this test a person swallows liquid barium, and x-rays are taken to follow the course of the barium through the esophagus and into the stomach.

blood tests

stool tests and cultures

esophageal motility tests, to evaluate the movement of food and other contents within the esophagus

pH tests to evaluate the acid contents of the esophagus

Prevention & Expectations

What can be done to prevent the condition?

A person can decrease his or her risk of hiatal hernia by:

staying at a healthy weight

limiting smoking and alcohol

eating a high fiber diet

not straining during bowel movements

using proper body mechanics, such as bending at the knees, during heavy lifting

wearing a seatbelt correctly

following sports safety guidelines for children, adolescents, and adults

Some causes of hiatal hernia cannot be prevented.

What are the long-term effects of the condition?

Hiatal hernias can cause gastroesophageal reflux disease (GERD). GERD is chronic heartburn from stomach acid backing up into the esophagus. Ulcers or irritation of the lining of the esophagus and upper stomach can also occur. Strangulation of the esophagus or stomach may also occur with this condition.

What are the risks to others?

Hiatal hernia poses no risk to others.

Treatment & Monitoring

What are the treatments for the condition?

Treatment of hiatal hernia is focused on treating and reducing symptoms. To reduce symptoms, a person should:

sleep with the head of the bed raised several inches

avoid citrus fruits, spicy foods, alcohol, smoking, and caffeine

eat small, frequent meals

maintain a healthy weight, or losing weight if obese

avoid eating within 2 hours before bedtime

avoid straining during bowel movements or heavy lifting

Medications that block acid production in the stomach or that make the stomach empty faster may help.

Surgery may be needed if symptoms are severe or persistent, or if there is a large hole in the diaphragm. The surgery is done to strengthen the diaphragm and decrease the size of the esophageal hiatus.

What are the side effects of the treatments?

Medications that block stomach acid production can cause nausea, headache, or diarrhea. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.

What happens after treatment for the condition?

For mild intermittent symptoms, treatment with antacids, watching diet and activity may control hiatal hernia. For more serious recurrent symptoms, surgery may be needed. Recovery from surgery may be a few days to several weeks depending on the procedure used.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Attribution

Author:Eileen McLaughlin, RN, BSN
Date Written:
Editor:Smith, Elizabeth, BA
Edit Date:10/03/00
Reviewer:Melissa Sanders, PharmD
Date Reviewed:09/25/00

Sources

http://www.niddk.nih.gov/health/digest/pubs/heartbrn/heartbrn.htm#hiatal

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

Complete Guide to Symptoms, Illness, and Surgery, H. Griffith, M.D., 2000

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