A hiatal hernia is a condition in which the upper part of the stomach moves up through a small opening in the diaphragm into the chest. The diaphragm is the muscular wall that separates the abdominal cavity from the chest cavity.

The different types of hiatal hernias include:

• Sliding hiatal hernia—the most common type in which the herniated part of the stomach slides back and forth, into and out of the chest
• Fixed hiatal hernia—the upper part of the stomach permanently remains in the chest
• Complicated hiatal hernia—Several other types of stomach herniation may be seen. These are uncommon but more serious and may require surgery.

Many people are born with the hiatal hernia but the cause is still unknown. It may result from a weakening of the supportive tissues.

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

• Age: 50 or older
• Obesity
• Smoking
• Pregnancy
• Abdominal injury
• Increased pressure in the abdomen from:
  • Severe coughing
  • Vomiting
  • Straining
  • Sudden physical exertion (eg, weight-lifting)

Most people with hiatal hernias have no symptoms.

Symptoms may occur when stomach acid moves up into the esophagus (swallowing tube). This is known as gastroesophageal reflux disease (GERD) and can cause:

• Heartburn , especially after eating or lying down
• Pain or discomfort in the stomach, chest, or esophagus
• Belching
• Hoarseness
• Throat irritation (frequent clearing of the throat)
• Chest pain
• Difficulty swallowing
• Bleeding from the stomach or esophagus

Because they often have no symptoms, hiatal hernias are sometimes only detected during a visit to the doctor for other ailments. A hiatal hernia is usually diagnosed with the following tests:

• Upper GI series —a series of x-rays of the upper digestive system taken after drinking a barium solution, to show the outline of the digestive system.
• Endoscopy —A camera mounted on a thin, lighted tube is inserted through the mouth into the esophagus or swallowing tube. At this time, a biopsy or sample of tissue may be taken to check for any complications, including:
  • Inflammation
  • Scar tissue
  • Abnormal cells called Barrett's esophagus that can develop into cancer

Hiatal hernias are usually treated only when there are symptoms. When GERD is present, the following measures may help:

For people who are obese, losing weight may relieve symptoms.

Avoid foods that can relax the muscle that controls the opening between the esophagus and the stomach including:

• Chocolate
• Peppermint
• Fatty foods
• Coffee
• Alcoholic beverages

Avoid foods and beverages that can irritate the internal lining of the esophagus, such as:

• Caffeine
• Citrus fruits and juices
• Tomato products
• Hot peppers
• Carbonated beverages

To minimize acid reflux:

• Consume smaller meals 4-6 times a day versus three large meals.
• Avoid drinking large amounts of fluids with meals.
• Do not eat within 2-3 hours of bedtime.

If you smoke, quit. Smoking weakens the lower esophageal sphincter, a muscle that controls the opening between the esophagus and the stomach.

• Wear clothes and belts that are loose around your waist.
• Avoid stooping or bending after meals, which puts increased pressure on the abdomen.

Elevating the head of the bed on 6-inch blocks or sleeping on a specially designed wedge reduces heartburn. This position helps prevent stomach contents from refluxing backward into the esophagus.

Antacids can neutralize acid and temporarily relieve heartburn.

For chronic reflux and heartburn, several types of medications may be prescribed to reduce acid in the stomach. These include:

• H2 blockers such as:
  • Cimetidine
  • Famotidine
  • Nizatidine
  • Ranitidine
• Proton pump inhibitors such as:
  • Omeprazole
  • Esomeprazole
  • Lansoprazole
  • Pantoprazole
  • Rabeprazole

Surgery may be needed if:

• You have severe GERD symptoms that do not respond to other treatments.
• The hernia is at risk for twisting, which could cut off the blood supply to part of the stomach and cause that part to die.