Hiatal Hernia

A hiatal hernia occurs when part of the stomach pushes upward through the opening in the diaphragm where the esophagus passes into the abdomen. Some hiatal hernias cause no symptoms, while others can contribute to heartburn, acid reflux, difficulty swallowing, chest discomfort, or other digestive symptoms.

Treatment depends on the type and size of the hernia, the symptoms it causes, and whether complications are present. Many patients can manage symptoms without surgery, while others may benefit from surgical hiatal hernia repair.

What Is a Hiatal Hernia?

The diaphragm is a large muscle that separates the chest from the abdomen and plays an important role in breathing. The esophagus passes through a small opening in the diaphragm called the esophageal hiatus before connecting to the stomach.

A hiatal hernia develops when part of the stomach moves upward through this opening and into the chest.

What Are the Types of Hiatal Hernias?

Hiatal hernias are classified according to which parts of the stomach and surrounding structures move through the diaphragm.

Sliding Hiatal Hernia

A sliding hiatal hernia, also called a type I hiatal hernia, occurs when the junction between the esophagus and stomach moves above the diaphragm.

This is the most common form of hiatal hernia and is frequently associated with gastroesophageal reflux.

Paraesophageal Hiatal Hernia

With a paraesophageal hernia, part of the stomach moves through the diaphragm alongside the esophagus.

Types II, III, and IV hiatal hernias are forms of paraesophageal hernias. Larger or more complex paraesophageal hernias may require closer evaluation because additional portions of the stomach or, in some cases, other abdominal organs can move into the chest.

What Are the Symptoms of a Hiatal Hernia?

Many small hiatal hernias do not cause noticeable symptoms and may be discovered during testing for another condition.

When symptoms occur, they may include:

• Heartburn
• Acid reflux
• Regurgitation of food or liquid
• Difficulty swallowing
• Chest or upper abdominal discomfort
• Feeling full soon after eating
• Shortness of breath, particularly with a larger hernia
• Nausea or digestive discomfort

Symptoms vary considerably, and their severity does not always correspond directly to the size of the hernia.

Does a Hiatal Hernia Cause Acid Reflux or GERD?

A hiatal hernia can contribute to gastroesophageal reflux disease (GERD), but the two conditions are not the same.

GERD occurs when stomach contents repeatedly flow backward into the esophagus. A hiatal hernia may weaken the normal barrier that helps prevent this reflux, making GERD more likely in some patients.

However, it is possible to have:

• A hiatal hernia without GERD
• GERD without a hiatal hernia
• Both conditions at the same time

Learn more about the difference between a hiatal hernia and heartburn.

What Causes a Hiatal Hernia?

The exact cause of a hiatal hernia is not always known.

Changes or weakness in the tissues surrounding the opening in the diaphragm can allow the stomach to move upward into the chest.

Factors associated with hiatal hernias may include:

• Age-related changes in the diaphragm
• Increased pressure within the abdomen
• Persistent coughing or vomiting
• Straining during bowel movements
• Repeated heavy lifting
• Obesity
• Pregnancy
• Previous injury or surgery involving the area
• Being born with a larger-than-normal opening in the diaphragm

Hiatal hernias become more common with age and are also more common among people with obesity.

How Is a Hiatal Hernia Diagnosed?

Hiatal hernias are sometimes discovered while a patient is being evaluated for heartburn, reflux, chest discomfort, or upper abdominal symptoms.

Testing may include:

Upper GI X-Ray or Esophagram

An X-ray examination using contrast can show the shape and position of the esophagus and stomach and help identify a hiatal hernia.

Upper Endoscopy

An upper endoscopy uses a thin, flexible tube with a camera to examine the esophagus and stomach. It can also help identify inflammation or other changes associated with reflux.

Esophageal Manometry

Esophageal manometry measures the pressure and coordination of the muscles used during swallowing. It may be used as part of the evaluation before certain types of hiatal hernia or antireflux surgery.

Additional testing may be recommended depending on the patient's symptoms and whether reflux or another condition is suspected.

Does a Hiatal Hernia Need Treatment?

Not every hiatal hernia requires treatment.

If a hiatal hernia is small and does not cause symptoms, treatment may not be necessary. Patients who experience heartburn or reflux may initially be treated with lifestyle changes and medication.

Treatment decisions are based on factors such as:

• Type and size of the hernia
• Severity and frequency of symptoms
• Presence of GERD
• Difficulty swallowing
• Response to nonsurgical treatment
• Anatomy of the stomach and esophagus
• Risk or presence of complications
• Overall health

How Is a Hiatal Hernia Treated Without Surgery?

For patients whose primary symptoms involve acid reflux or heartburn, treatment may begin with measures designed to reduce reflux.

These may include:

• Eating smaller meals
• Avoiding lying down soon after eating
• Identifying foods or beverages that worsen reflux
• Weight management when appropriate
• Elevating the head during sleep when recommended

Medications may also be used to manage reflux symptoms. Depending on the patient, these can include antacids, H2-receptor blockers, or proton pump inhibitors.

These treatments can help control symptoms, but they do not physically repair the opening in the diaphragm.

When Does a Hiatal Hernia Need Surgery?

Surgery is not necessary for every hiatal hernia.

Hiatal hernia surgery may be considered when symptoms are significant, complications are present, or appropriate nonsurgical treatment does not adequately control the patient's condition.

A surgical evaluation may be appropriate for patients with:

• Persistent or severe symptoms
• Significant reflux despite appropriate treatment
• A symptomatic paraesophageal hernia
• Difficulty swallowing related to the hernia
• A large or complex hiatal hernia
• Complications associated with the hernia
• Certain recurrent hiatal hernias

Whether surgery is appropriate should be determined individually after reviewing the patient's symptoms, anatomy, test results, overall health, and treatment goals.

How Is Hiatal Hernia Surgery Performed?

The goal of hiatal hernia repair is generally to return the stomach to its appropriate position below the diaphragm and repair the opening around the esophagus.

The specific surgical technique varies according to the patient's anatomy and condition.

Minimally Invasive Hiatal Hernia Repair

Many hiatal hernia repairs can be performed using laparoscopic or robotic-assisted techniques.

These approaches use several small incisions through which the surgeon accesses the abdomen and repairs the hernia.

Fundoplication

A fundoplication may be performed along with hiatal hernia repair, particularly when reflux is an important part of the patient's condition.

During fundoplication, part of the upper stomach is wrapped around the lower portion of the esophagus to reinforce the barrier between the stomach and esophagus and reduce reflux.

Different forms of fundoplication are available, and the appropriate technique depends on the individual patient.

What Is Recovery Like After Hiatal Hernia Surgery?

Recovery varies based on the type and complexity of the repair, the surgical approach, and the patient's overall health.

After surgery, patients may receive specific instructions regarding:

• Diet progression
• Incision care
• Walking and other light activity
• Lifting restrictions
• Returning to work
• Resuming exercise
• Follow-up appointments

Dietary changes are often required during the early stages of recovery while the repaired area heals.

Your surgeon will provide individualized guidance about when you can return to normal eating, lifting, exercise, work, and other activities.

When Should You Seek Medical Care for a Hiatal Hernia?

Persistent reflux, difficulty swallowing, chest discomfort, or other ongoing symptoms should be evaluated by a healthcare professional.

Seek prompt medical attention for severe or rapidly worsening symptoms, particularly:

• Severe chest or abdominal pain
• Persistent vomiting
• Vomiting blood
• Black or tarry stools
• Significant difficulty swallowing
• Sudden worsening of symptoms

Chest pain can have causes unrelated to a hiatal hernia, including serious heart or lung conditions. New or severe chest pain should not automatically be assumed to be caused by a hernia.

Hiatal Hernia Surgery in the East Bay

Hernia Innovations provides evaluation and surgical treatment for hiatal hernias in the East Bay.

Our board-certified surgeons evaluate each patient's symptoms, anatomy, diagnostic testing, and previous treatments to determine whether nonsurgical management or surgical repair may be appropriate.

When surgery is recommended, the surgical approach is selected based on the type and complexity of the hiatal hernia and the individual patient's needs.

Call (925) 940-1025 or request an appointment online.

Frequently Asked Questions About Hiatal Hernias

Is a hiatal hernia serious?

Many hiatal hernias cause few or no symptoms and do not require surgery. Larger or symptomatic hiatal hernias can cause reflux, difficulty swallowing, chest or abdominal discomfort, and, less commonly, complications that may require surgical treatment.

Can a hiatal hernia go away on its own?

A hiatal hernia does not typically resolve on its own. However, a hernia that causes no symptoms may not require treatment, and reflux-related symptoms can often be managed without surgery.

What does a hiatal hernia feel like?

Some people do not feel a hiatal hernia at all. When symptoms occur, they may include heartburn, acid reflux, regurgitation, difficulty swallowing, chest or upper abdominal discomfort, or feeling full quickly after eating.

What is the difference between a sliding and paraesophageal hiatal hernia?

A sliding hiatal hernia occurs when the junction between the stomach and esophagus moves above the diaphragm. With a paraesophageal hernia, part of the stomach moves through the diaphragm alongside the esophagus. Paraesophageal hernias include types II, III, and IV.

Does every hiatal hernia need surgery?

No. Many hiatal hernias can be monitored or managed with treatment for associated reflux symptoms. Surgery may be considered for symptomatic, large, complicated, or certain paraesophageal hernias and when appropriate nonsurgical treatment does not adequately control symptoms.