Hiatus Hernia

A hiatus hernia (or hiatal hernia) is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm.

Types of hiatus hernia

There are two major kinds of hiatus hernia:

The most common (95%) is the sliding hiatus hernia, where the gastroesophageal junction moves above the diaphragm together with some of the stomach.

The second kind is rolling (or paraesophageal) hiatus hernia, when a part of the stomach herniates through the esophageal hiatus and lies beside the esophagus, without movement of the gastroesophageal junction. It accounts for the remaining 5% of hiatus hernias.

Symptoms

Hiatus hernia has often been called the “great mimic” because its symptoms can resemble many disorders. For example, a person with this problem can experience dull pains in their chest, shortness of breath (caused by the hernia’s effect on the diaphragm), and heart palpitations (due to irritation of the vagus nerve).

In most cases however, a hiatal hernia does not cause any symptoms. The pain and discomfort that a patient experiences is due to the reflux of gastric acid, air or bile. While there are several causes of acid reflux, it does happen more frequently in the presence of hiatal hernia.

What causes a hiatus hernia?

The following are risk factors that can result in a hiatus hernia.

  • Increased pressure within the abdomen caused by:
    • Heavy lifting or bending over
    • Frequent or hard coughing
    • Hard sneezing
    • Pregnancy and delivery
    • Violent vomiting
    • Straining with constipation
    • Obesity (extra weight pushes down on the abdomen increasing the pressure)
    • Use of the sitting position for defecation[3] (See epidemiology below)
  • Heredity
  • Smoking
  • Drug use, such as cocaine.
  • Stress
  • Diaphragm weakness

Diagnosing a hiatus hernia

The diagnosis of a hiatus hernia is typically made through an upper GI series or endoscopy.

Treatment

Please read our hiatus hernia treatments page.