Hiatal Hernia

What Is It?

A hernia occurs when part of an internal organ or body part protrudes through an opening into another area where it shouldn't. A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. Normally, the esophagus (the tube that carries food to the stomach) goes through this opening. In a hiatal hernia, a portion of the stomach and/or the section where the stomach joins the esophagus (called the gastroesophageal junction) slips through the hiatus into the chest.

There are two types of hiatal hernias:

• Sliding — A part of the stomach and the gastroesophageal junction slip into the chest. Sliding hiatal hernias are common, especially in smokers, overweight people and women older than 50. These hernias are related to naturally occurring weaknesses in the tissues that normally anchor the gastroesophageal junction to the diaphragm and to activities or conditions that increase pressure within the abdomen. These activities or conditions include persistent or heavy coughing, vomiting, straining while defecating, sudden physical exertion and pregnancy.
• Paraesophageal — The gastroesophageal junction remains in its proper place and only a portion of the stomach slips into the chest. Of the two types of hiatal hernias, paraesophageal hernias are more likely to cause severe symptoms.

Symptoms

Sliding hiatal hernias may not cause any symptoms or they may cause heartburn that is worse when you lean forward, strain or lie down. There may be chronic belching and, sometimes, regurgitation (backflow of stomach contents into the throat).

In some cases, a paraesophageal hernia may slide into the chest and become trapped (incarcerated) and unable to slide back into the abdomen. If this happens, there is a danger that the trapped hernia may die because its blood supply is cut off (strangulated). Symptoms of a strangulated hiatal hernia include sudden severe chest pain and difficulty swallowing. This situation requires immediate medical treatment.

Diagnosis

Your doctor will ask about any history of heartburn or chest discomfort, especially if it seems to be related to eating a heavy meal, bending forward or heavy lifting.

Your doctor may suspect that you have a hiatal hernia based on your symptoms and risk factors (age, obesity, smoking, occupation that requires heavy lifting). To confirm the diagnosis, your doctor may order one or more of the following tests:

• Chest X-ray — A simple X-ray may show a large hiatal hernia.
• — A viewing tube is inserted down the throat to inspect the esophagus.