Hiatal Hernia

When your stomach pushes upward through your diaphragm, a hiatal hernia occurs. The name is derived from the small opening, or “hiatus,” through which your esophagus passes on its way to connect to your stomach.

A hiatal hernia is usually caused by weakened muscle tissue which allows your stomach to bulge up through your diaphragm. The weakness may be borne of pressure on your stomach and age-related changes in your diaphragm. The condition may also be caused by:

  • Injury to the area
  • Being born with an unusually large hiatus
  • Persistent and intense pressure on the surrounding muscles, such as when coughing, vomiting or straining during a bowel movement, or while lifting heavy objects

There are almost no symptoms for a small hiatal hernia. Most of the time, you won't even know you have this condition. A hiatal hernia is usually discovered by your doctor when he is checking for some other condition.

Larger hiatal hernias may cause the following symptoms:

  • Heartburn
  • Belching
  • Difficulty swallowing
  • Chest or abdominal pain
  • Feeling especially full after meals
  • Vomiting blood or passing black stools

See your doctor if you have any persistent signs or symptoms that worry you. Your doctor will likely use one or more of the following procedures for his diagnosis:

  • Blood testing, to check for anemia due to loss of blood;
  • An barium swallow, that will provide a clear picture of your esophagus, stomach and the upper part of your small intestine for a subsequent X-ray;
  • An endoscopy exam, during which a thin, flexible tube equipped with a video camera is inserted down your throat and into your esophagus;
  • Manometry, during which a catheter is passed through your nose, down through the esophagus and into the stomach to measure pressure and movement inside the esophagus.

Most cases of hiatal hernia do not require any treatment. However, if you are experiencing acid reflux, your doctor may prescribe antacids or other medications to reduce acid production in your stomach.


In a very small number of cases where medications are not effective, your doctor may perform surgery most often involving pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac.