Hiatal hernia

Definition:

A condition in which a portion of the stomach protrudes upward into the chest through an opening in the diaphragm (the sheet of muscle used in breathing that separates the chest from the abdomen).

Alternative Names:

Hernia - hiatal

Causes, incidence, and risk factors:

The cause is unknown, but hiatal hernias may be the result of a weakening of the supporting tissue. Increasing age, obesity, and smoking seem to be risk factors in adults.

Children with this condition usually have it present at birth (congenital). It is usually associated with gastroesophageal reflux in infants.

Hiatal hernias are very common, especially in people over 50 years old. This condition can cause regurgitation of gastric acid from the stomach into the esophagus.

Symptoms:

heartburn, worse when bending over or lying down
swallowing difficulty
chest pain
belching

Note: Frequently there are no symptoms.

Signs and tests:

Treatment:

The goals of treatment are to relieve symptoms and prevent complications.

Medical therapy is aimed at reducing regurgitation of stomach contents into the esophagus (gastroesophageal reflux). Medications that neutralize stomach acidity, decrease acid production or strengthen the lower esophageal sphincter may be prescribed.

Other measures to reduce symptoms include:

avoiding large or heavy meals
never lying down or bending over immediately after a meal
weight reduction and smoking cessation

Failure to control the symptoms by general or medical measures or the onset of complications may require surgical repair of the hernia.

Expectations (prognosis):

Most symptoms are alleviated with treatment.

Complications:

slow bleeding and iron deficiency anemia (large hernia)
pulmonary (lung) aspiration
strangulation of the hernia (closing off of the hernia)

Calling your health care provider:

Call your health care provider if symptoms indicate you may have developed a hiatal hernia.

Call your health care provider if you have a hiatal hernia and symptoms worsen or do not improve with treatment, or if new symptoms develop.

Prevention:

Controlling risk factors like obesity may play a preventative role.

Review Date: 5/21/2002
Reviewed By: Andrew J. Muir, M.D. M.H.S., Division of Gastroenterology, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.

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