Health Topics for Digestive System

James A. Clifton Center for Digestive Diseases

Cancers of the Digestive System

Liver Failure Clinic

Liver Service

Hiatal Hernia

A hernia occurs when an internal organ protrudes through a gap or opening in the wall around it. When a hiatal hernia is present, the stomach protrudes through the opening in the diaphragm where the esophagus or food pipe joins the stomach. The diaphragm is the large muscle that divides the chest from the abdomen. The opening in the diaphragm is called the esophageal hiatus. The hiatus helps to keep the stomach contents from backing up into the esophagus. When there is muscle weakness or too much abdominal pressure the stomach can slip through the hiatus causing a hiatal hernia.

The causes of hiatal hernia may include:

• overweight
• pregnancy
• tight clothes
• heavy lifting or weight lifting
• coughing
• abdominal injury and
• straining (such as when having a bowel movement)

Many people over the age of 50 have a hiatal hernia. They may never know it because often there are not any symptoms. If the hernia is small and does not cause any symptoms, there is no need for treatment. If the hernia is larger, it may cause symptoms like heartburn.

People who have heartburn once in a while may have a hiatal hernia. Occasional heartburn can be treated with over-the-counter antacids. If heartburn becomes severe or occurs more often, a healthcare provider should be consulted. These may be symptoms of gastroesophageal reflux disease or GERD.

Hiatal hernia may cause or make the symptoms of GERD worse. Heartburn is the main symptom of GERD. Heartburn is caused when stomach acid gets into the esophagus. The esophagus does not have the special protective lining that the stomach does. The acid can cause irritation of the esophagus.

If a hiatal hernia is causing symptoms, some of the following may help:

• eat small meals more often
• avoid foods and drinks that cause symptoms
• avoid lying down for 3 hours after a meal
• put blocks under the head of the bed to raise it 4 to 6 inches
• avoid tight clothes around the waist
• take antacids or medicines, like H2 blockers that reduce the stomach acid
• lose weight

A small number of people may continue to have problems with GERD even with lifestyle changes. When this happens the provider can prescribe other medicines, or stronger H2 blockers. If the problems with GERD continue surgery may be necessary. Surgery should not be considered until all other measures have been tried. The surgery can be done with a cut in the chest or abdomen. A newer type of surgery involves the use of small cuts. A special instrument called a laparoscope is used to do the surgery through the small cuts.

Anyone with a large hiatal hernia with severe chest pain, trouble breathing, or swallowing should get medical care immediately.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIL File DIGE4417.rf2 VRS# 4417 Data Version 7.0 Copyright 1998, 2000, 2002 McKesson Health Solutions LLC. All rights reserved.