A hiatal hernia is a protrusion of the stomach or esophagus through the diaphragm. The diaphragm is a thin structure that separates the chest cavity from the abdominal cavity. The end of esophagus (swallowing tube) typically joins the top of the stomach underneath the diaphragm in the abdominal cavity. However, in patients with a hiatal hernia, the esophagus, and sometimes the stomach, can partially protrude up through an opening in the diaphragm into the chest cavity. There are two types of hiatal hernias: sliding (most common) and para-esophageal. The types differ based on what part of the stomach and esophagus have herniated through the diaphragm.
What are the symptoms of a hiatal hernia?
Hiatal hernias are very common and many patients don’t have any symptoms at all! If patients do have symptoms, heartburn or acid reflux are the most commonly reported. Some patients also have chest or upper abdominal discomfort, trouble swallowing, belching or nausea.
How are hiatal hernias diagnosed?
Most are found during an upper endoscopy, though some imaging studies such as CT, barium swallow or upper GI series can also diagnose hiatal hernias.
What treatment options are available?
Treatment of hiatal hernias are usually based on the symptoms. If a patient has mild acid reflux, symptoms will typically resolve with dietary and lifestyle modifications and acid lowering medications. A smaller subset of patients with larger hernias or refractory symptoms will undergo a surgical or endoscopic intervention to repair the hernia and tighten the junction between the esophagus and stomach.