Hiatus hernia

A hiatus hernia occurs when one of the organs in your abdomen (tummy) pushes up into your chest area through a hiatus (opening) in your diaphragm.

Key points

  • Your diaphragm is a large thin muscle between your chest and abdomen. 
  • Most often, the organ that pushes through the diaphragm to create a hiatus hernia is your stomach, but it can also be your pancreas, spleen or small intestine.
  • A hiatus hernia has different causes, symptoms and treatment to an abdominal hernia.
  • A hiatus hernia is a common condition. Some studies suggest that up to half of people having tests for indigestion have a hiatus hernia. It occurs more often in men.
  • Although you may have a hiatus hernia with no symptoms, it can lead to gastro-oesophageal reflux or GORD. Nearly all patients with severe GORD have a hiatus hernia.
  • It's rare for a hiatus hernia to cause complications, but long-term damage to the oesophagus (the tube connecting mouth and stomach) caused by leaking stomach acid can lead to ulcers, scarring and changes to the cells of your oesophagus, which can increase your risk of oesophageal cancer. 
Two diagrams showing a normal stomach and one with hiatus hernnia

What are the causes of a hiatus hernia?

A hiatus hernia tends to occur from your diaphragm weakening as you age or from too much pressure being put on your abdomen. This means those people most likely to get a hiatus hernia are:

  • pregnant
  • obese, or
  • over 50 years old.

What are the symptoms of a hiatus hernia?

Although a hiatus hernia doesn’t cause symptoms, the factors that normally prevent your stomach acid from refluxing (going back up) into your oesophagus may not work so well (such as the sphincter muscle and the normal pressure of the diaphragm).

This refluxed acid can cause inflammation of the lower part of your oesophagus, which can mean you may:

  • feel heartburn (a burning feeling from your stomach up to your throat)
  • have pain in your upper abdomen and chest
  • get an acid taste in your mouth
  • belch
  • have difficulty swallowing.

How is a hiatus hernia diagnosed?

If you have the symptoms listed, see your doctor. Hiatus hernias can usually be diagnosed by an x-ray or an endoscopy.

What is the treatment for a hiatus hernia?

If you are experiencing symptoms, the best treatment is to make lifestyle changes (see below), and, if necessary, take medicine. Surgery is usually only recommended if other treatments haven't worked.

Medicines

Medicines are often used to relieve the symptoms of hernia such as heartburn or GORD. They do not treat the hernia itself. Examples of commonly used medicines include:

  • Antacids such as Alu-tab®, Chewy Quick-Eze®, Mylanta P®. These usually contain magnesium or aluminium and work by neutralising (weakening) the acid in your stomach, which can reduce the symptoms of heartburn and relieve pain. Read more about antacids.
  • H2-receptor blockers such as ranitidine and famotidine. These reduce the production of stomach acid and relieve indigestion, pain and discomfort. They are slower acting than antacids but provide longer-term symptom relief. Possible side effects may include diarrhoea, headaches, tiredness and a rash.
  • Proton pump inhibitors (PPIs) such as omeprazole and lansoprazole. These block stomach acid production and help to heal your oesophagus. Side effects can include headaches, diarrhoea, feeling sick or constipation. Read more about proton pump inhibitors.

How can I care for myself if I have a hiatus hernia?

You can help yourself by making the following lifestyle changes:

  • eat smaller meals more often, rather than three large meals a day
  • avoid lying down (including going to bed) for three hours after eating or drinking
  • don’t dig the garden or lift or move heavy objects soon after eating
  • avoid eating or drink anything that makes your symptoms worse (such as hot, spicy or acidic food, or fizzy drinks)
  • lose excess weight
  • avoid tight clothing around your stomach
  • raise the head end of your bed
  • quit smoking
  • reduce your caffeine and alcohol.

How do I prevent a hiatus hernia?

To prevent a hiatus hernia, follow the suggestions about lifestyle changes above.

Learn more

Hiatus hernia NHS Choices, UK, 2014
Hiatus hernia Patient Info, UK, 2017
Hiatus hernias The British Hernia Centre, UK, 2017  

References

  1. Hiatus hernia Patient Info, UK, 2017
  2. Risk factors in the aetiology of hiatus hernia: a meta-analysis Eur J Gastroenterol Hepatol. 2011 Feb 23(2):133-8.
  3. Managing gastro-oesophageal reflux disease (GORD) in adults: an update Best Practice Journal. 2014 June
  4. Hiatus hernia NHS, UK, 2015