A hiatus hernia occurs when part of the stomach pushes up into the chest through the diaphragm.

The diaphragm is a muscle that separates the chest cavity from the abdominal cavity. The gullet goes down the chest cavity through a gap (hiatus) in the diaphragm before joining the stomach. When part of the stomach goes through the hiatus into the chest, a hiatus hernia is formed.

What causes a hiatus hernia?

A hiatus hernia occurs when the diaphragmatic muscle becomes weak, stretching the hiatus and allowing the top part of the stomach to bulge through into the chest cavity.

It is not always clear why a hiatus hernia has occurred, but there are a number of factors that increase your risk, including:

  • Age 50+
  • Female
  • Obesity
  • Pregnancy

Types of hiatus hernia:

There are two main types of hiatus hernia:

  • Sliding hiatus hernia, or type 1 hiatus hernia – This is by far the most common type (80%). The top of the stomach pushes up into the chest at the junction of the gullet and the stomach.
  • Para-oesophageal hernia, rolling hiatus hernia, or type 2 hiatus hernia – These make up about 15% of all hiatus hernias. In such cases the stomach goes up into the chest alongside the gullet, with the junction between the gullet and the stomach often remaining inside the abdomen.

What are the symptoms of a hiatus hernia?

Small hiatus hernias don’t usually cause any symptoms and are often discovered incidentally while carrying out other investigations.

However, hiatus hernias can cause symptoms such as:

  • Chronic heartburn or gastro-oesophageal reflux disease
  • Regurgitation and vomiting
  • Choking sensations
  • Difficulty swallowing
  • Excessive belching
  • Upper abdominal pain

How is a hiatus hernia diagnosed?

A hiatus hernia may be discovered while investigating causes of upper abdominal pain. If suspected, the following tests will help confirm the diagnosis:

  • Upper GI endoscopy or gastroscopy
  • X-ray of the chest and upper abdomen, or barium swallow/meal
  • CT scan (especially in complex para-oesophageal hiatus hernias)

How is a hiatus hernia managed?

Sliding hiatus hernias do not necessarily cause symptoms and treatment may focus on managing the associated chronic acid reflux including: lifestyle changes, antacid medications and in a small group of patients, anti-reflux surgery.

Para-oesophageal hiatus hernias may cause difficulty with swallowing and abdominal pain, especially after eating. Sometimes the pain is relieved by vomiting, suggesting intermittent stomach obstructions.

Surgical repair is usually necessary to alleviate these symptoms and prevent the risk of stomach twisting (volvulus), which can lead to strangulation/perforation of the stomach in a minority of patients.

Please ensure you consult a healthcare professional before making decisions about your health.