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A hiatal hernia occurs when the upper region of the stomach protrudes through the opening of the diaphragm. This condition is highly common, particularly with aging. While it usually does not cause any symptoms, they are associated with acid reflux when it does.
Fortunately, there are several treatments available for hiatal hernias causing symptoms.
By Able Health I Medically reviewed by Dr. Alireza Estedlal
Page last reviewed: February 2024 I Next review due: February 2026
A hiatal hernia happens when the top part of the stomach shoves into the chest through an opening in the diaphragm. The muscle block separating the abdominal cavity and chest cavity is the diaphragm. A hernia arises when a tissue or organ pushes through a weak spot in the tissue barrier containing it. Generally, hernias are frequent, with hiatal hernias being one of the most known types.
Hiatal hernias shove through an already existing weakness within the diaphragm, specifically at the opening, whereby the esophagus connects to the stomach. Doctors refer to the opening as esophageal hiatus, and this is where the term hiatal hernia, or hiatus hernia, originates.
With time, stress can enlarge this opening. Typically, this condition progresses slowly over several years.
The two primary forms of hiatal hernias include sliding hiatal hernias and paraesophageal hiatal hernias. A wide range of individuals experience the sliding type, which is categorized as type 1. The other 3kindsare all paraesophageal hernias.
People with sliding hiatal hernia type, which is the most prevalent, are unlikely to feel the hernia. Also, they won’t possibly notice a bulge on the outer area, unlike in other forms of hernias.
Most individuals with hiatal hernias never experience any symptoms. However, for those who do, the common symptoms are usually associated with chronic acid reflux (gastroesophageal reflux disease, or GERD), including:
Not all people with a hiatal hernia experience acid reflux, and not everybody with acid reflux also has a hiatal hernia. However, if you have lately started noticing these symptoms more frequently, then they could be connected.
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Book an appointmentA hernia is likely to occur whenever there is a weakness in the tissues separating different compartments of the body. This weak point allows the hernia to push through by creating an opening. A hiatal hernia specifically emerges through an existing opening, the esophageal hiatus, in which the esophagus goes through the diaphragm. This opening just needs to widen slightly for the hiatal hernia to develop.
At times, surgery, particular injuries, or birth defects can lead to initial weakness, resulting in hernia formation. However, it is more commonly because of cumulative damage caused by years of day-to-day stress. Anything producing more pressure in the abdominal cavity can gradually wear down the diaphragm with time. Common factors that contribute to the increased abdominal pressure and the creation of hiatal hernias are:
In general, hiatal hernias are more likely to occur in individuals who:
The common issue that is mostly caused by hiatal hernias is chronic acid reflux. If severe and drugs inadequately manage it, chronic acid reflux could damage the esophagus with time.
Some of the complications linked to chronic acid reflux are:
In rare cases, a hiatal hernia can lead to complications if it becomes stuck or pressed in the hiatus. This is more likely, especially with the less common forms of hiatal hernias. The possible complications are:
Doctors diagnose hiatal hernias by examining images of the esophagus and stomach. At times, they are discovered incidentally while assessing other issues.
The provider will look for a hiatal hernia if you are experiencing symptoms of acid reflux. They may start by performing an esophageal pH test in order to confirm the presence of acid in the esophagus. If acid is found, further imaging tests will be used to determine the cause.
Diagnostic tests that might help detect hiatal hernia are:
To determine the ideal long-term treatment method for your condition, the doctor will carefully assess the nature of the hernia, reflux as well as the symptoms.
For occasional reflux, over-the-counter (OTC) antacids can be used to address the condition. However, for more frequent reflux, a prescription for long-term, everyday use is required.
Proton pump inhibitors (PPIs) are commonly prescribed to help prevent and repair damage caused by acid in the esophagus. Nonetheless, they cannot stop regurgitation or prevent the hernia progression.
A surgical procedure to repair a hernia may be recommended when:
Hiatal hernia surgical procedure corrects the hernia as well as acid reflux by:
The procedure is known as fundoplication, a term that refers to the top region of the stomach called the fundus. The surgery involves wrapping the fundus all over the lower esophagus and attaching it with stitches or surgical staples. This helps tighten the muscle, separating both organs (lower esophageal sphincter). Whenever possible, this operation is performed using minimally invasive laparoscopic surgery.
Your doctor can accidentally detect the hiatal hernia while diagnosing a different problem. Hiatal hernias are very common; however, if you have a small one that isn’t bothering you, then there’s no need for concern. On the other hand, you might notice a hiatal hernia after experiencing worsening symptoms over the years, finally prompting you to find solutions and relief. It might come as a shock to know that a hernia is the underlying basis of your acid reflux.
The good news is that both hiatal hernias and acid reflux are treatable. The appropriate treatment for you depends on the nature as well as the symptoms of the condition. Mostly, medication and lifestyle modifications are sufficient in managing acid reflux. But, in more serious situations, surgery may be required to repair the hernia. This procedure is highly effective, and after confirming the diagnosis, you will get relief from your symptoms.