If you often have heartburn or discomfort in the chest area after eating or laying down, one potential cause may be a hiatal hernia. Some people with a hiatal hernia have minimal symptoms, while others experience ongoing discomfort related to acid reflux or pressure in the chest.
Most hiatal hernias can be managed with lifestyle changes and medication. In some cases, surgery may be recommended to relieve symptoms or prevent complications.
At Banner Health, our providers will listen to your concerns, evaluate your symptoms and make a care plan that works for you.
Your diaphragm is a large muscle that helps you breathe. It separates your chest from your abdominal cavity (stomach area). There is a small opening in the diaphragm called the hiatus. The esophagus (the tube that carries food to your stomach) passes through this opening.
A hiatal hernia happens when the top part of your stomach pushes through the hiatus into your chest. When this happens, the normal barrier that keeps acid in your stomach can no longer work properly. This can cause heartburn, make it hard to swallow, and allow stomach acid and food to come back up into your esophagus.
Hiatal hernias are divided into four types based on how much of the stomach (or other organs) moves into the chest.
This is the most common type. A sliding hiatal hernia occurs when the lower esophagus and the top of the stomach move up into the chest and then move back down. This type is often associated with acid reflux.
This type is not as common but more serious because the stomach can become trapped. With type 2, the upper part of the stomach pushes up next to the esophagus and doesn’t slide back down easily.
Type 3 is a combination of types 1 and 2. Both the lower part of the esophagus and a larger part of the stomach move up into the chest. More of the stomach is above the diaphragm. This type has a higher risk of complications and often needs surgery.
This type is very rare and serious. Part of the stomach moves up into the chest. Other organs, like the colon, small intestine and spleen, may also shift upward. Like type 3, complex hiatal hernias usually need surgery to reduce the risk of complications.
A hiatal hernia happens when a weak spot in the tissue lets your stomach push up through your diaphragm. Sometimes, it's not clear why this occurs but certain factors can raise your chances of getting it.
In many cases, muscle tissue weakens over time and increased pressure inside the abdomen can push the stomach upward. However, for many people, there is no one specific cause that can be found.
Some people have no symptoms but larger hiatal hernias can cause:
If acid reflux happens often or does not improve, it may be gastroesophageal reflux disease (GERD). GERD is more serious and can irritate and damage the esophagus over time.
Paraoesophageal, type 3 and type 4 hernias may cause:
Although rare, the stomach can become trapped or lose blood supply. If this happens, it is a medical emergency. Call 911 or go to the emergency room if you have:
Your health care provider will start with a physical exam and ask you about your symptoms. You might need one or more tests, including:
Treatment depends on the type of hernia and the severity of your symptoms.
For many people, simple changes reduce symptoms:
Your provider may recommend:
These medications relieve symptoms and help protect your esophagus.
Learn more about these medication options.
You may need surgery if:
Many surgeries are performed using minimally invasive techniques. This usually means smaller incisions (cuts), less pain and faster recovery.
The most common operation is called a fundoplication. During the surgery, the stomach and lower esophagus are moved back under the diaphragm. The surgeon closes the hole in the diaphragm where the hernia appeared. The stomach is then wrapped around the lower esophagus to create a new reflux valve. This helps keep the stomach in place and prevents acid reflux.
Most people do very well after hiatal hernia surgery. For most, heartburn and acid reflux get better or go away completely. Swallowing usually becomes easier and most people no longer need daily acid-reducing medicines.
After surgery, you might need to eat soft foods for a while and avoid heavy lifting while you heal. Some people feel bloated or have trouble burping at first but these problems usually get better over time.
The results often last a long time. There is a chance the hernia could come back but surgery is usually safe and works well when done by experienced surgeons. Your care team will monitor your recovery and help you every step of the way as you heal.
Untreated hiatal hernias can lead to:
Type 2, 3 and 4 hernias can cause stomach strangulation or bleeding.
Make an appointment if you have:
Seek emergency care for severe chest pain or trouble breathing.
At Banner Health, we provide complete care for hiatal hernias and acid reflux. Our team includes primary care providers, gastroenterologists and surgeons who specialize in digestive conditions. We work together to help you feel better, protect your digestive health and return you to normal activities.
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