standard-title Hiatal Hernia

Hiatal Hernia

Hiatal Hernia


About Condition

Hiatal Hernia

A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.

In most cases, a small hiatal hernia doesn’t cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition.

But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.

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Signs and Symptoms

Most small hiatal hernias cause no signs or symptoms. However, larger hiatal hernias can cause signs and symptoms such as:

  • Heartburn
  • Belching
  • Difficulty swallowing
  • Chest or abdominal pain
  • Feeling especially full after meals
  • Vomiting blood or passing black stools, which may indicate gastrointestinal bleeding

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Risk Factors

Hiatal hernia is most common in people who are:

  • Age 50 or older
  • Obese

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Diagnostic Process

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. Such tests or procedures include:

  • Blood testing. Your doctor may recommend a complete blood count to check for anemia due to blood loss.
  • An esophagram (barium swallow). During this procedure, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
  • Endoscopy. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.
  • Manometry. During this test, a thin, pressure-sensitive tube (catheter) is passed through your nose, down through the esophagus and into the stomach. The catheter then measures pressure and movement inside the esophagus.

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Treatment Options

Surgery to repair a hiatal hernia

In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for emergency situations, which are rare, and for people who aren’t helped by medications to relieve heartburn and acid reflux.

An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.

In some cases, surgery is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).

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Patient Stories

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