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Hiatal Hernia

A hiatal hernia occurs when the top of the stomach pushes through a weak spot or hole in the diaphragm. They rarely require treatment but may cause symptoms like acid reflux or GERD that are usually managed with medications and lifestyle changes. Serious cases could require surgery to repair the hernia with mesh.

Last Modified: May 17, 2024
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What Is a Hiatal Hernia?

A hiatal hernia occurs when part of the stomach pushes through an opening in the diaphragm and into the chest cavity. This may allow stomach acid into the esophagus, causing acid reflux symptoms.

While femoral, epigastric and inguinal hernias happen when the organs or tissues push through the abdominal wall, hiatal hernias push through weak spots or holes in the diaphragm. The diaphragm is a thin muscle that separates the abdomen and chest cavity and prevents stomach acid from backing up into the esophagus.

“Statistics reveal that 60% of adults will have some degree of a hiatal hernia by age 60, and even these numbers do not reflect the real prevalence of the condition because many hiatal hernias can be asymptomatic.”

The specific cause of hiatal hernias is unknown, but most occur when the diaphragm muscle around the esophagus becomes weak. Conditions like pregnancy that increase the pressure in the abdomen area can contribute to the development of a hernia. Hiatal hernias are common, with over half of all adults developing some degree of the condition.

According to research from the Baylor College of Medicine, “Statistics reveal that 60% of adults will have some degree of a hiatal hernia by age 60, and even these numbers do not reflect the real prevalence of the condition because many hiatal hernias can be asymptomatic.”

Hiatal Hernia Types

The two main types of hiatal hernias are sliding and paraesophageal.

Sliding Hiatal Hernia

In this type of hiatal hernia, at the point where the esophagus meets the stomach, part of the stomach slides upward into the chest cavity through an opening in the diaphragm called the hiatus. People with sliding hiatal hernias may experience heartburn from gastroesophageal reflux disease.

Sliding hernias are the most common type of hiatal hernia, with an estimated 25% of adults developing one by age 40. They account for over 95% of hiatal hernias. Most sliding hernias don’t require surgery to repair the problem unless lifestyle changes and medications to reduce stomach acid fail to alleviate symptoms.

Paraesophageal Hiatal Hernia

In a paraesophageal hiatal hernia, the stomach and sometimes other abdominal organs push up through the opening in the diaphragm alongside the esophagus. Paraesophageal hernias are less common and more serious because they have a higher risk for developing complications like incarceration, where the stomach gets stuck and forms a blockage, or ischemia, restricting blood flow to the stomach. Both of these conditions are a medical emergency and require immediate treatment.

A paraesophageal hernia that causes no discomfort or other symptoms may not require surgery. Medications are the first treatment attempt for symptoms like GERD. However, if chest pain, abdominal pain or difficulty swallowing develop, the patient usually requires surgery to repair the hernia.

It’s also possible to have combined hernias. This happens when sliding and paraesophageal hernias occur together.

Causes of Hiatal Hernia

It’s not always clear why a hiatal hernia happens, but intraabdominal pressure, muscle weakness and loss of elasticity contribute to the risk.

Causes and Risk Factors
  • Age-related changes to the diaphragm
  • Frequently lifting heavy objects
  • Obesity
  • Persistent coughing, straining or vomiting
  • Pregnancy
  • Smoking
  • Trauma from injury or previous surgery

Some people have a genetic predisposition to getting hiatal hernias because of congenital defects. They may have a larger-than-usual hiatus or looser connective tissues that make the area more susceptible to developing a weak spot.

Recognizing Symptoms of Hiatal Hernia

Many patients with hiatal hernias are asymptomatic, with only around 9% experiencing symptoms. Those that do appear generally resemble GERD or acid reflux symptoms.

Hiatal Hernia Symptoms
  • Abdominal pain
  • Acid reflux
  • Anemia
  • Belching
  • Bitter or sour taste
  • Bloating
  • Chest pain
  • Chronic cough
  • Feeling full immediately after eating small amounts of food
  • Heartburn
  • Regurgitation
  • Shortness of breath

Some symptoms are more serious and require immediate medical attention. Hiatal hernia patients should treat these as an emergency.

Severe Symptoms
  • Dysphagia or difficulty swallowing
  • High fever
  • Passing black stools
  • Rapid heart rate
  • Severe chest pain
  • Vomiting blood

Hiatal hernias can cause acid reflux and GERD because of the increased stomach acid in the airway. Other symptoms like chest pain and shortness of breath could indicate a heart problem or other serious medical issues. Patients should always report new or worsening symptoms to their doctor to rule out other conditions and receive treatment.

Diagnosing a Hiatal Hernia

Imaging tests are the most common way to diagnose hiatal hernias. The majority of people get diagnosed when they seek out treatment for acid reflux, GERD, abdominal pain or chest pain.

Diagnostic Tests
Barium Swallow and X-ray:
A doctor takes an X-ray of the upper digestive system after the patient drinks a liquid that fills and coats the digestive tract. This test can show the size of the hernia and if the stomach becomes twisted.
A doctor inserts a thin, flexible tube with a light at the end through the throat to examine the esophagus and stomach.
Esophagography Manometry:
This swallowing test measures the esophagus muscles' coordination and strength.
Gastric Emptying Studies:
These studies allow doctors to see how fast food leaves the stomach.
pH Test:
This test measures esophagus acid levels.

Getting an accurate diagnosis is critical to determine an effective treatment strategy. Patients who have mild symptoms and no complications can try medications, diet notifications and other strategies to reduce their symptoms. Others may require surgery to repair the hernia.

Treatment Options for Hiatal Hernia

Hiatal hernia treatment depends on the type and severity of the hernia. While these types of hernias don’t go away on their own, most are not serious and don’t require treatment.

Medications and Lifestyle Changes

Hernias that are asymptomatic or that only cause mild acid reflux symptoms are often managed with a balanced diet and lifestyle changes like losing weight and quitting smoking. Medications to treat symptoms of GERD are a popular and effective method for many patients. The most common are proton pump inhibitors like Nexium, Prilosec and Protonix.

It’s important to know that long-term use of these medications can cause serious side effects. PPI lawsuits claim these drugs caused kidney disease, kidney failure and other health complications, and that the drug manufacturers failed to warn patients of the possible dangers.


Hernia repair surgery is usually only recommended if the hernia causes symptoms uncontrolled with medications and changes to lifestyle, or if it becomes severe and causes complications. Most surgical treatments use hernia mesh to strengthen the weakened area and prevent the hernia from recurring.

Open hernia surgery involves making an incision to repair the hernia with sutures or synthetic mesh. It’s generally used for large hernias. Laparoscopic surgery is a minimally invasive procedure where the surgeon makes several small incisions to insert a camera and surgical tools to repair the hernia.

A surgeon may also perform a Nissen fundoplication, or GERD surgery, to reinforce the lower part of the esophagus by wrapping the top of the stomach around it. This procedure helps to prevent acid buildup.

Possibly Hiatal Hernia Surgery Complications
  • Bleeding
  • Delayed stomach emptying
  • Diarrhea
  • Difficulty swallowing
  • Esophageal narrowing
  • Excess gas
  • Fistulas
  • Heart injury
  • Hernia recurrence
  • Infection
  • Mesh erosion
  • Organ injury
  • Perforation of the esophagus and stomach

Surgery has generally good outcomes for providing relief of symptoms. Patients who undergo laparoscopic surgery typically have a shorter recovery and fewer complications.

Recovery from hernia surgery requires rest and diet changes. Most patients can return to their normal activities in one to three months. Patients should follow their doctor’s instructions on pain relief, wound care and diet restrictions during recovery. Anyone who experiences severe pain, fever, redness at the incision site, severe swallowing problems or the inability to pass gas or stool should contact their doctor immediately.

Hernia Mesh and Hiatal Hernia Repair Complications

As reported by the Annals of Laparoscopic and Endoscopic Surgery, surgeries that use hernia mesh for hiatal hernia can sometimes cause rare but serious problems that require reoperation. Polypropylene mesh is the most common material surgeons in the U.S. use. It usually provides the benefit of strengthening the hernia site and preventing it from returning. However, it also comes with certain risks.

Hernia mesh complications can include hernia mesh pain, infection, mesh erosion, narrowing of the esophagus and a large amount of scar tissue. Thousands of patients who suffered an injury from a failed mesh implant joined federal hernia mesh lawsuits to seek compensation.

Please seek the advice of a medical professional before making health care decisions.