What is a hiatal hernia?

A hiatal hernia happens when part of your stomach moves up through an opening in your diaphragm and into your chest.

Your digestive system begins at your mouth and carries food through your esophagus, which passes through a small opening in your diaphragm—called the esophageal hiatus—before reaching your stomach. Normally, this opening fits closely around the esophagus and helps prevent acid reflux, but with a hiatal hernia, the stomach pushes through this opening.

A hiatal hernia makes it harder for your body to keep stomach acid where it belongs, leading to symptoms like heartburn, regurgitation and trouble swallowing. As the hernia grows, you may experience chest pain, early fullness, a chronic cough or shortness of breath.

Unlike other hernias, hiatal hernias cannot be seen or felt from the outside. If symptoms don’t improve or your doctor needs a closer look, imaging tests or an endoscopy may help confirm the diagnosis.

Types of hiatal hernias

Hiatal hernias are classified by how much of the stomach (and nearby contents) move through the hiatus opening:

  • Type I (sliding): The most common type. The junction where your esophagus meets your stomach slides up and down through the hiatus.
  • Type II (paraesophageal): A rare form of hernia where part of the stomach herniates above the junction.
  • Type III (paraesophageal): Both the junction and part of the stomach move above the hiatus and do not reduce on their own.
  • Type IV (paraesophageal): A larger herniation where the stomach and another organ (often the colon) also herniate through the hiatus.

Hiatal hernia symptoms

A hiatal hernia is the most common cause of gastroesophageal reflux disease (GERD). Typical symptoms of a hiatal hernia include:

  • Heartburn or acid reflux
  • Indigestion (dyspepsia)
  • Regurgitation (food coming back up)
  • Swallowing problems (dysphagia)

Symptoms from a paraesophageal hernia include:

  • Chest pain or pressure
  • Early fullness
  • Difficulty swallowing
  • Shoulder pain
  • Bloating
  • Asthma-like symptoms

Less common symptoms:

  • Chronic cough
  • Voice hoarseness
  • Sinus drainage
  • Shortness of breath

When to see doctor

If heartburn, regurgitation or swallowing trouble happens often or affects your sleep, eating or daily comfort, talk with your doctor. Medications and lifestyle changes can help many people feel better, but ongoing symptoms may need further evaluation.

In rare cases, larger hiatal hernias can cause strangulation (loss of blood supply) or obstruction (blocked stomach), which are emergencies and require immediate surgery.

What causes a hiatal hernia?

A hiatal hernia can form when the tissue around the diaphragm opening weakens or stretches over time. Factors that may contribute include pregnancy, obesity, trauma, chronic coughing and repeated straining.

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Hiatal hernia risk factors

Hiatal hernias are common, affecting up to 30% of the US population. They are more prevalent in women (especially after age 55), and risk increases with age, obesity, chronic cough, constipation and genetic factors.

Complications

Most hiatal hernias cause symptoms but are not dangerous. Larger paraesophageal hernias carry more risk, including:

  • Barrett’s esophagus: Acid reflux can cause precancerous changes in the esophagus.
  • Esophagitis: Painful burning and ulceration of the esophagus lining.
  • Esophageal stricture: Scar tissue can narrow the esophagus, making swallowing difficult.
  • Strangulation or obstruction: Rare but serious emergencies requiring surgery where the stomach loses blood supply or can’t empty.

How is a hiatal hernia diagnosed?

A physical exam alone cannot detect a hiatal hernia.

Your doctor will diagnose a hiatal hernia based on your symptoms and imaging tests, such as barium swallow studies, CT scans or endoscopy.

Imaging and tests

Your doctor will likely need to order additional tests to diagnose a hiatal hernia. Tests can include:

  • Esophageal pH test: This test allows your doctor to measure acid levels in your esophagus for 24 hours or longer. This test will diagnose GERD, which is strongly associated with a hiatal hernia.
  • Barium swallow (esophagram): You’ll drink a contrast solution containing barium, which shows up easily on X-ray images. A radiologist will do the test using X-rays while you drink the contrast. The test helps show possible abnormalities around your esophagus and stomach.
  • EGD procedure (upper endoscopy): A gastroenterologist or surgeon will insert an endoscope that contains a camera to view the esophagus, stomach and first portion of the small bowel.
  • Esophageal manometry: This is a test to measure the function of your esophagus. It can show the impact a hiatal hernia has on your esophagus.

Hiatal hernia treatment

Not all hiatal hernias need treatment. If symptoms are present, treatment with antacids is tried first. Surgery is considered if medications don’t help or if the hernia is large or causes complications. Surgery for a hiatal hernia can also be used in cases for people who don’t wish to take antacids or have allergy restrictions.

Lifestyle changes

While lifestyle changes won’t heal a hernia, they can help you manage symptoms of acid reflux and GERD. Your doctor may recommend:

  • Avoid trigger foods (acidic, spicy, high-fat)
  • Eat smaller portions
  • Elevate the head of your bed
  • Lose weight
  • Quit smoking
  • Limit alcohol and caffeine

Find specialized care for a hiatal hernia near you

At Baylor Scott & White Health, we offer care for hiatal hernias at specialized surgical centers across North and Central Texas. Our experienced team provides personalized care to help improve your quality of life.

Frequently asked questions

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