Hiatal Hernia

What is Hiatal Hernia?

Hiatal hernia is a condition characterized by a protrusion of the upper part of the stomach through the diaphragm. The diaphragm is a muscular layer present between the abdominal cavity and the chest cavity and aids in breathing. It has an opening called the hiatus through which the oesophagus or food pipe passes to reach the stomach. When the stomach protrudes upwards through the hiatal opening, it is called a hiatal hernia.

Types of Hiatal Hernia

There are two types of hiatal hernia:

  • Sliding Hernia: This is the most common type of hiatal hernia in which the lower part of the oesophagus and upper part of the stomach protrudes into the chest cavity and can slide back out into normal position. This usually occurs when the hernia is small and is mostly asymptomatic.
  • Fixed/Paraesophageal Hernia: This is a rare and potentially dangerous form of hiatal hernia in which the junction between the oesophagus and stomach remains below the diaphragm but part of the stomach protrudes through the hiatus, squeezes against the oesophagus and cannot slide back out. This is also called a strangulated hernia. The blood flow to this part of the stomach can get blocked resulting in tissue damage. 

Causes of Hiatal Hernia

Hiatal hernia may be caused by:

  • Weakening of the diaphragm muscles with age, pregnancy, or obesity.
  • Abdominal injury
  • Increased abdominal pressure during bowel movements, vomiting or coughing
  • Fluid accumulation in the abdominal cavity 
  • Congenital defect where the hiatus is abnormally large

Symptoms of Hiatal Hernia

Most people with hiatal hernia do not have symptoms. People with large hiatal hernias may experience symptoms as acid from the stomach enters the oesophagus (acid reflux). These symptoms include:

  • Heartburn (burning sensation and discomfort in the chest)
  • Burping
  • Coughing
  • Shortness of breath
  • Bloating
  • Difficulty in swallowing
  • Regurgitation of food
  • Bitter taste
  • Pain in the abdomen or chest
  • Stomach upset
  • Vomiting
  • Abdominal bleeding

Diagnosis of Hiatal Hernia

Your doctor will review your medical history and symptoms and order certain diagnostic tests such as:

  • Barium swallow test: You will be instructed to drink a small amount of barium liquid which helps visualize the oesophagus and stomach on X-rays.
  • Endoscopy: This study uses an endoscope which is a thin, flexible tube with a camera and a light attached to its end that is inserted through your throat into the oesophagus.
  • CT scan: This scan uses a special x-ray machine to produce clear images of the oesophagus and stomach.
  • pH monitoring: This test helps detect the level of the acid in the oesophagus. 
  • Oesophageal Manometry: This study records the oesophagal muscle contraction and its movement while swallowing food

Treatment for Hiatal Hernia

In most people, hiatal hernia produces no symptoms or mild symptoms. Few present with severe symptoms. The treatment methods vary based on the severity of the condition and include:

Conservative methods

Lifestyle remedies:

  • Maintain a healthy weight
  • Have smaller meals more frequently
  • Drink plenty of water
  • Avoid going to bed immediately after a meal
  • Avoid smoking
  • Avoid strenuous abdominal exercises
  • Include high-fibre content in your diet
  • Avoid intake of caffeine, chocolate, spicy foods and other items that can worsen the condition
  • Regular exercises


Your doctor will suggest over the counter medications such as antacids, proton pump inhibitors and H-2 receptor blockers that helps to neutralize and prevent acid production in stomach and oesophagus

Surgery: If conservative methods are found to be ineffective, surgery will be recommended.

Laparoscopic surgery is usually performed. This is a minimally invasive technique where your surgeon will make five or six small incisions on the abdomen through which a laparoscope which is a thin flexible tube with a camera and light attached to its end will be inserted along with other surgical instruments. The camera captures images which are displayed on a monitor to help your doctor guide the instruments while performing surgery. Surgery may include: 

  • Pulling the herniated portion of the stomach down into the abdominal cavity
  • Reducing the size of the hiatal opening
  • Fundoplication: The upper part of the stomach, called the fundus is wrapped around the lower portion of the oesophagus to strengthen closure of the sphincter between the oesophagus and stomach. This helps control acid reflux.
  • The Clementine Churchill Hospital
  • NHS Royal Free London
  • UCL
  • NHS London North West
  • Royal College of Surgeons of England