Hiatus Hernia: Causes, Symptoms, Diagnosis and management approaches

A hiatus hernia is a common condition that affects the upper part of the digestive system. It occurs when part of the stomach pushes upward through an opening in the diaphragm called the hiatus. The diaphragm is a large muscle that separates the chest from the abdomen and helps with breathing. Normally, the oesophagus passes through the hiatus before joining the stomach. In someone with a hiatus hernia, part of the stomach can move through this opening and into the chest.

Hiatus hernias are particularly common in people over the age of 50, although they can occur at any age. Many people have a hiatus hernia without experiencing any symptoms and may only discover it during tests for another condition.

Types and Causes of Hiatus Hernia

There are two main types of hiatus hernia: sliding and para-oesophageal. A sliding hiatus hernia is the most common type. In this condition, the junction between the oesophagus and stomach, along with part of the stomach, moves upward through the diaphragm. This movement can occur intermittently, particularly when pressure within the abdomen increases.

A para-oesophageal hernia is less common. In this case, part of the stomach pushes through the diaphragm alongside the oesophagus while the junction between the oesophagus and stomach remains in its normal position. Although some people have no symptoms, larger para-oesophageal hernias can occasionally cause complications.

The exact cause of a hiatus hernia is not always clear. Factors that may increase the risk include ageing, obesity, pregnancy and increased pressure within the abdomen. Persistent coughing, repeated vomiting, straining during bowel movements and lifting heavy objects may also contribute to increased abdominal pressure. Weakness in the muscles and connective tissues around the diaphragm can also make a person more susceptible.

Symptoms

Many people with a hiatus hernia have no symptoms. When symptoms do occur, they are often associated with acid reflux. This happens because the hernia can affect the normal barrier between the stomach and oesophagus, allowing stomach acid to travel upwards.

Common symptoms include heartburn, particularly after eating, acid or food coming back into the mouth, difficulty swallowing, chest or upper abdominal discomfort, frequent burping and feeling unusually full after meals. Some people may also experience a persistent cough, sore throat or hoarse voice as a result of acid reaching the throat.

Symptoms can sometimes become worse when lying down, bending over or eating a large meal. However, symptoms vary considerably between individuals.

Diagnosis

A hiatus hernia may be suspected based on a person's symptoms and medical history. If further investigation is required, doctors may recommend tests such as an upper gastrointestinal endoscopy. During this procedure, a flexible camera is passed through the mouth to examine the oesophagus and stomach.

Other tests may include a barium swallow, in which a patient drinks a liquid that can be seen on X-rays, or imaging such as an X-ray or CT scan. In some cases, additional tests may be performed to investigate persistent reflux or swallowing problems.

management approaches and Management

management approaches depends on the severity of symptoms. If a hiatus hernia is not causing problems, management approaches may not be necessary. For people experiencing reflux symptoms, lifestyle changes can often be helpful.

These may include eating smaller meals, avoiding lying down soon after eating, maintaining a healthy weight and identifying foods or drinks that trigger symptoms. Common triggers can include fatty foods, spicy foods, chocolate, caffeine, alcohol and acidic foods, although triggers differ from person to person. Raising the head of the bed can also help people who experience reflux at night.

Medicines may be recommended to reduce stomach acid. Antacids can provide short-term relief, while medicines such as proton pump inhibitors can reduce acid production and are commonly used for persistent reflux.

Surgery is not usually required, but it may be considered when symptoms are severe, persistent despite appropriate management approaches, or when complications develop. Surgical procedures aim to return the stomach to its normal position and strengthen the barrier between the stomach and oesophagus.

When to Seek Medical Advice

Although a hiatus hernia is often harmless, persistent or severe symptoms should be assessed by a healthcare professional. Chest pain should not automatically be assumed to be caused by reflux, particularly if it is sudden, severe or associated with breathlessness, sweating, dizziness or pain spreading to the arm, jaw or back, as these can be signs of a heart problem.

Difficulty swallowing, vomiting blood, black stools, unexplained weight loss or persistent vomiting also require prompt medical assessment.

Conclusion

A hiatus hernia is a common condition in which part of the stomach moves through the diaphragm into the chest. While many people experience no symptoms, others develop heartburn and acid reflux. Lifestyle changes and medication can often control symptoms effectively, and surgery is reserved for selected cases. Understanding the condition and recognising persistent or concerning symptoms can help people seek appropriate medical advice and management approaches.

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