Hiatus Hernia Symptoms

A hernia is when part of the body bulges or protrudes into another part of the body that would not normally contain it. In the case of a hiatus hernia, a part of the stomach, normally in the abdomen, slides or protrudes into the chest cavity.

Normal anatomy

The chest and abdomen are normally separated by the diaphragm, a thin sheet of muscle that aids in breathing. The oesophagus (the tube that food passes down from the mouth to the stomach) goes down through the chest, passing through a small opening (called a hiatus) in the diaphragm and entering the abdominal cavity to join the stomach.

Hiatus hernia

When a hiatus hernia occurs, a portion of the stomach is able to slide upwards through the opening in the diaphragm, beside the oesophagus, into the chest.

There are 2 main types of hiatus hernia.

• Sliding hiatus hernia: this is the most common type of hiatus hernia, accounting for about 90 per cent of cases. It occurs when the junction between the oesophagus and the upper part of the stomach protrude up through the oesophageal opening in the diaphragm into the chest cavity. The herniated portion of the stomach can slide back and forth, into and out of the chest.
• Rolling hiatus hernia: this is sometimes called a para-oesophageal hiatus hernia. In this case, the junction of the oesophagus and stomach stays down within the abdomen, and the top part of the stomach (the fundus) bulges up into the chest cavity. This type of hernia normally remains in one place, sitting next to the oesophagus, and does not move in or out when you swallow.

Common symptoms

The most common symptoms of hiatus hernia are those arising from gastro-oesophageal reflux, which can occur as a result of the hernia.

These symptoms include:

• heartburn, which is a painful burning sensation felt in the lower front chest area behind the breastbone and upper abdomen, often after eating or when lying down; and
• regurgitation of sour or bitter-tasting acid fluid into the mouth, particularly at night, which occurs with more severe reflux.

These symptoms are often worse when you bend over, lie down or strain to lift heavy objects.

Depending on the type of hiatus hernia, other symptoms can include:

• belching or burping;
• difficulty in swallowing; and
• pain on swallowing (especially hot drinks).

Difficulty breathing

Sometimes with large hiatus hernias there is so much of the stomach protruding up through the oesophageal gap in the diaphragm that it presses on your lungs and can make breathing more difficult. See your doctor if you are having difficulty breathing.

The outlook

In most cases, symptoms from a hiatus hernia can be kept under control with medicines and lifestyle and dietary changes to treat gastro-oesophageal reflux — your doctor can help you with these.

Other treatment, such as surgery, is normally only required if your symptoms become worse and more constant. Rolling, or para-oesophageal, hernias are more likely to require surgery than sliding hiatus hernias.