A hiatus hernia, or hiatal hernia, is when part of the stomach squeezes into the chest through an opening in the diaphragm called the hiatus.
The diaphragm is a large, thin sheet of muscle located between the chest and the abdomen (tummy).
Hiatus hernia and heartburn
A hiatus hernia itself rarely has any noticeable symptoms. However, it can cause a problem called gastro-oesophageal reflux disease (GORD).
GORD is when stomach acid leaks into the oesophagus (the tube which carries food to the stomach). It can occur if a hiatus hernia prevents the valve at the bottom of the oesophagus from working properly.
Your oesophagus can become severely irritated because it is not protected against stomach acid. This may result in symptoms such as heartburn, chest pain, an unpleasant sour taste in your mouth and problems swallowing (dysphagia).
You should see your GP if you have frequent and severe symptoms of GORD.
Who is affected
Hiatus hernia can affect anyone, but it's more common in women and people who are over 50, overweight, pregnant or who smoke. It's estimated that a third of people over 50 have a hiatus hernia.
There's also a rare type of hiatus hernia that affects newborn babies.
Why it happens
It's not exactly clear what causes hiatus hernia, but it may be the result of the diaphragm becoming weak with age or pressure on the abdomen.
Hiatus hernia can occur in newborn babies if the stomach or diaphragm doesn't develop properly.
Types of hiatus hernia
There are two main types of hiatus hernia:
- Sliding hiatus hernias - Hernias that move up and down, in and out of the chest area. Over 80% of hiatus hernias are this type.
- Para-oesophageal hiatus hernias - Where part of the stomach pushes up through the hole in the diaphragm next to the oesophagus. They're sometimes called rolling hiatus hernias. About 5-15% of hiatus hernias are this type
This information mainly focuses on sliding hiatus hernias.
The type of hiatus hernia can usually be diagnosed using an X-ray or an endoscopy (where a long, tube-like viewing instrument that contains a video camera and light source) is used.
Read more about diagnosing a hiatus hernia.
Treating hiatus hernia
Treatment for sliding hiatus hernia usually focuses on relieving the symptoms of GORD, such as heartburn.
Lifestyle changes and medication are the preferred treatments. Surgery is usually only recommended as an alternative to long-term medication or if other treatments haven't worked.
Lifestyle advice may include:
- eat smaller, more frequent meals - rather than three large meals a day
- avoid lying down (including going to bed) for three hours after eating or drinking
- remove any foods or drinks from your diet that make your symptoms worse
If a hiatus hernia isn't causing any noticeable problems, then it doesn't usually need to be treated.
Para-oesophageal hiatus hernias are repaired surgically if there is a risk of serious complications (see below).
Read more about treating hiatus hernia.
Further problems
It's rare for a hiatus hernia to cause complications, but long-term damage to the oesophagus due to leaking stomach acid can lead to ulcers, scarring and changes to the cells of the oesophagus which can increase your risk of oesophageal cancer.
Read more about the complications of hiatus hernia.
