Hiatus hernia is the term used to describe a condition where part of the stomach pushes up into the lower chest through a defect in the diaphragm. The diaphragm is the large flat muscle that separates the lungs from the tummy (abdomen), which helps us to breathe. Not everyone with a hiatus hernia develops symptoms. However, if you have a hiatus hernia you more prone to reflux acid into your gullet (oesophagus), which can cause heartburn and other symptoms. If symptoms do occur, treatment with acid-suppressing medication usually works well.
What is a hernia and what is a hiatus hernia?
A hernia occurs when part of an organ pushes (protrudes) through a muscular wall that holds it in place. There are different types of hernia. For example, an inguinal hernia is the most common type when part of the lower bowel protrudes through the muscle in the groin.
A hiatus hernia occurs when part of the stomach protrudes through the diaphragm.
What are the symptoms of hiatus hernia?
Acid reflux symptoms
Heartburn: this is the main symptom. This is a burning feeling which rises from the upper tummy (abdomen) or lower chest up towards the neck. (It is confusing as it has nothing to do with the heart!)
Other common symptoms include: pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching and a burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go and tend to be worse after a meal.
Some uncommon symptoms may occur. If any of these symptoms occur, it can make the diagnosis difficult, as these symptoms can mimic other conditions. For example:
A persistent cough, particularly at night, sometimes occurs. This is due to the refluxed acid irritating the windpipe (trachea). Asthma symptoms of cough and wheeze can sometimes be due to acid reflux.
Other mouth and throat symptoms sometimes occur such as gum problems, bad breath, sore throat, hoarseness and a feeling of a lump in the throat.
Severe chest pain develops in some cases (and may be mistaken for a heart attack).
However, people with a hiatus hernia who do get reflux, on average, tend to get more severe symptoms and problems associated with acid reflux. This may be because with a hiatus hernia any acid that gets into the oesophagus is more likely to remain in contact with the lining of the oesophagus for longer compared with people without a hiatus hernia.
How is a hiatus hernia diagnosed?
A hiatus hernia may be diagnosed if you have tests for symptoms of reflux. A special X-ray test called a barium swallow is the most accurate way to confirm the presence of a hiatus hernia. Endoscopy is increasingly being used. An endoscope is a thin, flexible telescope which is passed down the gullet (oesophagus) into the stomach. This allows a doctor or nurse to look inside. A hiatus hernia may be seen.
What is the treatment of hiatus hernia?
If you have no symptoms, in most cases you do not need any treatment. The hiatus hernia usually causes no harm. Occasionally, if you have a hernia which is at risk of complications, you may be offered surgery, even if you do not have any symptoms.
If you have reflux symptoms, you should aim to lose weight if you are overweight. Also, avoid anything that causes pressure on your stomach, such as tight clothing and corsets.
If you are a smoker you should aim to stop. If you drink a lot of alcohol, it also helps tocut down on alcohol.
Raising the head end of the bed may help with symptoms at night.
If changing your lifestyle does not help, you may need medication. Medicines which reduce the action or production of stomach acid, such as antacids or proton pump inhibitors, may help.
Rarely, a hiatus hernia causes severe symptoms of reflux which are not helped so well with medication. Therefore, an operation is occasionally advised. During this operation the stomach is put back into the correct position and the weakened diaphragm muscle around the lower gullet (oesophagus) is tightened. The operation is usually done these days using a laparoscope (a telescope inserted into the stomach). The surgery is called Laparoscopic Fundoplication
What are the possible complications of a hiatus hernia?
Narrowing (a stricture). If you have severe and long-standing inflammation it can cause scarring and narrowing of the lower oesophagus. This is uncommon.
Twisting (volvulus) or strangulation (trapping of the hernia with blockage of the circulation). These are rare complications which can occur with some types of hiatus hernia.
Barrett's oesophagus. In this condition the cells that line the lower oesophagus change. The changed cells are more prone than usual to becoming cancerous. (About 1 or 2 people in 100 with Barrett's oesophagus develop cancer of the oesophagus.)
Cancer. Your risk of developing cancer of the oesophagus is slightly increased compared with the normal risk if you have long-term acid reflux. This small increased risk is slightly higher still in people with reflux plus a hiatus hernia. This is because reflux problems, on average, tend to be more severe in people with a hiatus hernia compared to those without a hiatus hernia.