Hiatal hernia is a condition in which the upper part of the stomach bulges through the diaphragm, which is a muscular barrier between the chest and the abdomen that helps inflate and deflate the lungs during breathing.
There is a small opening in the diaphragm called the hiatus, through which the esophagus passes on its way to the stomach. In patients with hiatal hernia, the stomach is forced — or “herniated” — through the hiatus into the chest. This can impact the function of the lower esophageal sphincter (LES), a ring of muscle at the lower end of the esophagus that helps keep stomach contents and acid from being regurgitated into the esophagus.
Because hiatal hernia can compromise the proper function of the LES, hiatal hernia can cause gastroesophageal reflux disease (GERD). GERD is a chronic and sometimes painful condition in which the tissues of the esophagus are repeatedly exposed to stomach acid. Left untreated long term, GERD can increase a person’s risk of developing other serious conditions, including Barrett’s esophagus and esophageal cancer.
Because hiatal hernias often cause no symptoms, people can have a hiatal hernia for years without knowing it. The condition is very common, especially in older people. According to the National Institutes of Health, 55% to 60% of people in the U.S. over the age of 50 have a hiatal hernia, but only about 9% have noticeable symptoms.
Types of Hiatal Hernias
There are four types of hiatal hernia:
- Type I, known as a “sliding hernia,” occurs when the gastroesophageal junction (GEJ) — the point where the esophagus and stomach meet — is shifted upwards toward the hiatus. More than 95% of diagnosed hiatal hernias are type I.
- Type II, also called a paraesophageal hiatal hernia, happens when part of the stomach is pushed into the mediastinum, which is the middle part of the chest, between the pleural cavities that hold the lungs.
- Type III combines traits of both paraesophageal hernia and sliding hernia, with both the GEJ and part of the stomach pushed into the mediastinum.
- Type IV happens when both the stomach and another abdominal organ like the colon, spleen or small intestine is pushed into the chest.
Why Hoag for Hiatal Hernia Evaluation and Treatment?
Need treatment for hiatal hernia in Orange County? Trust the Hoag Digestive Health Institute to help you heal. Hoag’s comprehensive, fully-integrated Foregut Program is the area’s recognized leader in the treatment of chronic conditions of the esophagus, stomach and lower esophageal sphincter. Our program offers a patient-centered approach, drawing on the latest advancements in techniques and technology to help patients find lasting, life-changing treatment options they just can’t get anywhere else.
Symptoms and Causes of Hiatal Hernia
The symptoms of hiatal hernia can be different for every person, and many people experience no symptoms at all. In those who do experience noticeable complications of hiatal hernia, common symptoms include:
- Recurring acid reflux, AKA “heartburn”
- Feeling full soon after eating, even if you only ate a small meal
- Abdominal pain, or pain in the esophagus
- Recurring belching
- Difficulty swallowing
- Chest pain
- Chronic cough
- Unexplained fatigue
- Vomiting blood, or digested blood which looks like coffee grounds (serious cases)
- Passing black or tarry bowel movements, which may indicate internal bleeding
- Having gastroesophageal reflux disease (GERD), a chronic condition in which stomach acid and partially-digested stomach contents are regurgitated into the esophagus. The condition is usually caused by a malfunctioning lower esophageal sphincter (LES), and can increase your risk of Barrett’s esophagus and esophageal cancer.
Causes of Hiatal Hernia
The reason people develop a hiatal hernia is different for every patient. However, there are some known causes and risk factors that may make it more likely you will develop a hiatal hernia. These may include:
- Trauma to the lower chest or abdomen, such as from a seatbelt during an auto accident or being hit in the abdomen with great force
- A birth defect that causes a person to have an unusually large hiatus through their diaphragm
- Being obese
- Recurring, intense pressure on the abdomen, which can potentially be caused by:
- Weightlifting for exercise
- Chronic cough
- Lifting heavy objects at work
- Forceful, recurring vomiting
- Straining to have a bowel movement while constipated
Diagnosis and Tests for Hiatal Hernia
If you visit a doctor with symptoms that suggest you might have a hiatal hernia, he or she will likely ask you questions about your medical history and symptoms, followed by a thorough medical exam.
Depending on the results of that exam, your doctor may ask you to complete further tests to confirm or rule out hiatal hernia. These tests may include:
- Upper gastrointestinal (GI) endoscopy, in which a specialist puts a long, flexible tube with a light and a camera on the tip into your mouth, down the esophagus and into the stomach, both to look for problems and potentially collect tissue samples for examination in a lab. Explore Hoag’s Orange County endoscopy centers located near you
- Barium swallow X-ray, in which you’ll be asked to swallow a chalky substance called barium before having an X-ray of your abdomen. The barium coats the internal surfaces of the esophagus and stomach, making those organs and their position easier to see in medical imaging
- Esophageal manometry, which is a test that measures the strength of the contractions in your esophagus during swallowing and whether those contractions are efficiently moving food to the stomach
Orange County’s Most Advanced Diagnosis of Conditions of the Esophagus and Stomach
As Orange County’s recognized leader in the accurate diagnosis and treatment of conditions involving the stomach and esophagus, the Hoag Digestive Health Institute is here for those facing conditions involving these crucial digestive organs, including GERD, Barrett’s esophagus and hiatal hernia.
At Hoag, advanced procedures used to diagnose or treat conditions involving the stomach and esophagus include:
- Abdominal Ultrasound
- Barium swallow X-ray
- Capsule studies
- Esophageal Bravo pH Monitoring
- Esophagogastroduodenoscopy (EGD)
- Endoscopic ultrasound (EUS)
- Esophageal Manometry (EM)
- Gastric emptying test (GET)
- Video esophagram
Many people with hiatal hernia experience no symptoms, and will never need treatment. However, if a person is experiencing bothersome or painful symptoms of hiatal hernia, like GERD or recurring chest pain, treatment may be required through lifestyle changes, medication or surgery.
Over-the-counter and prescription medicines may be used to treat some of the symptoms of hiatal hernia. Medications include:
- H2 receptor-blockers that reduce acid production in the stomach. Over-the-counter versions of these medicines include Tagamet HB, Pepcid AC and Axid AR. Stronger H2 blockers are available by persecution.
- Proton pump inhibitors, which are another form or medication that blocks acid production in the stomach, allowing damage to the esophagus to heal. Over-the-counter versions of these drugs including Prevacid, Prilosec and Zegerid
In severe cases or those that don’t respond to medication, surgery may be required to fix a hiatal hernia. Surgery for hiatal hernia most often involves pulling the stomach back into the abdomen, then making the hiatus through the diaphragm smaller to prevent the hiatal hernia from recurring. Surgery may also involve repairing or strengthening the lower esophageal sphincter to keep acid from being regurgitated into the esophagus.
At Hoag, hiatal hernia surgery is done laparoscopically, with the surgeon inserting instruments and a camera through small incisions in the abdomen.
Advanced Treatment Options for Gastroesophageal Reflux Disease (GERD) at Hoag
We’re committed to finding the latest and most advanced treatment options for conditions involving the esophagus and stomach. At Hoag, options for the treatment of GERD include:
- LINX Reflux Management System, which is an implantable, FDA-approved device that treats GERD symptoms and stops reflux. Hoag is one of only a handful of centers in California to offer this life-changing technology. Watch a short video about the LINX Reflux Management System.
- Nissen Fundoplication, which is a surgery to reinforce and strengthen the lower esophageal sphincter
- Toupet Fundoplication: Anti-Reflux Surgery, which a type of anti-reflux surgery that is most often used in cases where the patient has difficulty swallowing in addition to traditional reflux symptoms.
- Transoral Incisionless Fundoplication (TIF), which is a minimally invasive, non-surgical procedure that corrects a weakened esophageal sphincter, which causes chronic gastroesophageal reflux disease (GERD). The TIF procedure is performed entirely within the stomach, using an endoscope passed down the throat, and requires no incisions.
Prevention of Hiatal Hernia
There’s no known way to definitely prevent yourself from developing a hiatal hernia, However, there are certain steps you can take to reduce your risk of developing the condition. These may include:
- Eat a balanced, healthy diet and maintain a healthy weight
- Be cautious and know your limits during any activity that causes repeated strain to your abdominal muscles, including weightlifting for exercise, lifting heavy objects at work or at home, or doing abdominal exercises like crunches or sit-ups.
- Take steps to relieve constipation, including drinking plenty of water and eating a diet high in fiber. If you are constipated, avoid straining for long periods while trying to have a bowel movement
- When driving or riding in a vehicle, make sure the lap belt of the seatbelt passes over your body at the waist, not over your lower abdomen