Hiatal Hernia: Symptoms, Causes, Treatment, and Surgery | Easy-to-Understand Guide

Creator: Doctronic
Published: 2023-05-17

Medically reviewed by Jerome Albert Ecker | MD, Assistant Professor of Medicine, Duke University - Durham, NC on May 17th, 2023.

Key Takeaways

Two types exist: sliding hernias (95% of cases) where the stomach slides up and down through the diaphragm opening, and paraesophageal hernias which can cause life-threatening complications like strangulation.
Most people remain asymptomatic, but when symptoms occur they typically include heartburn, regurgitation of food, chest pain that mimics heart attack, and feeling full after small meals.
Age is the primary risk factor—50% of people over 50 have some degree of this condition due to weakening diaphragm muscles, with obesity and pregnancy increasing abdominal pressure that worsens the condition.
Proton pump inhibitors like omeprazole 20-40mg daily effectively control acid symptoms in 80% of patients, while H2 blockers provide faster but shorter-lasting relief.
Laparoscopic Nissen fundoplication surgery takes 1-3 hours with 90-95% long-term success rates, typically reserved for patients who don't respond to 8-12 weeks of medical therapy.

A hiatal hernia occurs when a part of your stomach pushes up through the diaphragm, the muscular wall that separates your chest from your abdomen. This condition can cause various symptoms and may require treatment. In this article, we'll explain hiatal hernias in simple terms, so you can better understand this condition and how to manage it.

What Is a Hiatal Hernia?

A hiatal hernia happens when a portion of your stomach bulges through the hiatus, an opening in your diaphragm that allows your esophagus (food pipe) to pass through to your stomach. This can cause the stomach to push up into your chest area.

Hiatal Hernia: Symptoms, Causes, Treatment, and Surgery | Easy-to-Understand Guide

Symptoms of Hiatal Hernias

Many people with hiatal hernias don't experience any symptoms. However, some common signs and symptoms may include:

Heartburn or acid reflux
Chest pain
Difficulty swallowing
Regurgitation of food or liquids into the mouth
Shortness of breath (in severe cases)

If you experience severe chest or abdominal pain, persistent vomiting, or inability to pass gas or have a bowel movement, seek medical attention immediately, as these could be signs of a strangulated hernia or obstruction.

Causes and Risk Factors

The exact cause of hiatal hernias is not always clear, but some factors that may contribute to their development include:

Being born with a larger-than-normal hiatal opening
Injury to the diaphragm area
Age-related changes in the diaphragm
Increased abdominal pressure due to pregnancy, obesity, coughing, heavy lifting, or straining during bowel movements

Hiatal hernias are more common in being female or assigned female at birth, people who are overweight, and those over the age of 50.

Diagnosing Hiatal Hernias

To diagnose a hiatal hernia, your doctor may perform one or more of the following tests:

Barium swallow X-ray
Endoscopy
Esophageal manometry (pressure study)
pH test to measure acid levels in the esophagus

Treatment Options for Hiatal Hernias

Treatment for hiatal hernias depends on the severity of the condition and the presence of symptoms. Options may include:

Watchful waiting for asymptomatic or mild cases
Medications to reduce stomach acid production and manage symptoms
Surgery to repair the hernia and reinforce the diaphragm opening

Hiatal Hernia Surgery

Hiatal hernia surgery has a high success rate, with about 90% of patients experiencing relief from symptoms and the ability to stop taking medications. The most common surgical approach is laparoscopy, which involves making small incisions in the abdomen and using a camera-guided instrument to repair the hernia. Recovery time is typically shorter with laparoscopic surgery compared to open surgery.

Lifestyle Changes and Home Remedies

In addition to medical treatment, certain lifestyle changes and home remedies can help manage the symptoms of hiatal hernias:

Avoid lying down or exercising for several hours after eating
Eat smaller, more frequent meals and chew food thoroughly
Limit or avoid acidic, fatty, and spicy foods, as well as alcohol and caffeine
Elevate the head of your bed by 6 inches and sleep on your left side
Maintain a healthy weight and avoid tight clothing that puts pressure on your abdomen
Quit smoking and limit alcohol, as both can worsen heartburn and reflux symptoms

By understanding the basics of hiatal hernias and implementing these lifestyle changes, you can better manage your symptoms and improve your overall quality of life. If you have concerns about your condition or experience severe symptoms, always consult with your healthcare provider for proper diagnosis and treatment.

For more information on hiatal hernias, visit:

The Bottom Line

Most cases respond well to acid-suppressing medications combined with eating smaller meals and sleeping with your head elevated 6-8 inches. Surgery becomes necessary only when medical management fails or complications develop like severe bleeding or obstruction. If you're experiencing persistent heartburn or chest pain that could indicate this condition, Doctronic can help you get a proper evaluation and treatment plan.