Hiatal Hernia - Topic Overview

What is a hiatal hernia?

A hiatal hernia (say "hi-AY-tul HER-nee-uh") occurs when part of your stomach bulges upward out of your belly and into your chest cavity.

There are three main types of hiatal hernia: sliding, paraesophageal, and mixed. A sliding hiatal hernia is generally not a serious condition. Paraesophageal and mixed hiatal hernias may get worse and are more serious.

More than 9 out of 10 hiatal hernias are sliding hiatal hernias. This topic focuses on sliding hiatal hernias.

What causes a hiatal hernia?

The belly (abdomen) and chest are separated by a muscle called the diaphragm. The esophagus, which is the muscular tube that connects the throat to the stomach, passes through an opening in the diaphragm called the hiatus.

A hiatal hernia is often caused by weakened muscles and connective tissue within and around the hiatus. In a sliding hiatal hernia, a small portion of the stomach pushes upward through the diaphragm at the hiatus and becomes positioned above the belly, inside the chest cavity. The valve (lower esophageal sphincter, or LES) between the esophagus and the stomach also moves up and away from the diaphragm.

See a picture of a sliding hiatal hernia.

What are the symptoms?

Most people who have a sliding hiatal hernia have no symptoms, and it often is diagnosed when a person is being evaluated for other health concerns. But when the lower esophageal sphincter slides up and away from the diaphragm, it may not close as well as it did before, and stomach acid and juices may back up into the esophagus (acid reflux). This results in an uncomfortable feeling of burning, warmth, heat, or pain behind the breastbone (sternum) that may occur after eating, soon after lying down, or when bending forward. And this feeling may come and go. You may also have a sour taste in your mouth. This group of symptoms is commonly known as heartburn or reflux.

If you have shortness of breath or pain in the area of your breastbone, you need to make sure it is not caused by a heart problem. The burning sensation caused by acid reflux usually occurs after eating. Pain from your heart is usually felt as pressure, heaviness, a weight, tightness, squeezing, discomfort, or a dull ache that occurs most often after activity. If you are not sure of the source of chest pain, call a doctor immediately.

How is a hiatal hernia diagnosed?

A hiatal hernia often is diagnosed when you are being evaluated for another health concern. A sliding hiatal hernia by itself may not have any symptoms, but it may lead to gastroesophageal reflux disease (GERD), which does cause symptoms-mainly heartburn. Often a hiatal hernia is diagnosed when you visit a doctor for symptoms of GERD.

How is it treated?

Treatment for mild symptoms begins with making lifestyle changes and, if needed, taking nonprescription antacids, acid reducers, or acid blockers. If symptoms are continual or severe, you may have GERD. Treatment for GERD usually requires prescription medications. Surgery is sometimes needed.  Dr Balder repairs severely symptomatic and refractory (patients whose symptoms are not controlled or are poorly controlled with medications) with advanced minimally invasive laparoscopic techniques.  In general, a repair will be done with HD laparoscopic equipment which allows HD visualization with 10 x magnification of the abdominal structures.  This then allows much better delineation of the surgical dissection than a surgeon could previously see with the naked eye.  Dr Balder can repair your hiatal hernia laparoscopically thru a few very small incisions generally about 5 mm in length.  This surgery brings your stomach back down into the abdominal compartment below the diaphram (flat breathing muscle below your lungs) from its previous abnormal position in the chest.  An anti-reflux procedure or "stomach wrap" typically is done at the junction between the esophagus and stomach with the hernia repair to help control post operative acid reflux problems.  This is because most hiatal hernia patients have a defective lower esophageal sphincter - or tightening mechanism which is supposed to prevent acid back-up back into the esophagus.  

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