What is a Hiatus Hernia?
A hiatus hernia occurs when part of the stomach pushes up through the diaphragm into the chest cavity.
The diaphragm is the muscle wall that separates the abdomen from the chest and helps in breathing.
At its base is an opening called the hiatus, through which the esophagus passes to connect to the stomach.
In a normal setting, the stomach stays below the diaphragm — but in the case of a hiatus hernia, it slips upward through this opening, causing discomfort, heartburn, and sometimes serious complications.
This condition is common, especially among people over 50. Many with small hernias don’t realize they have one, while larger hernias can cause severe reflux, chest pain, and difficulty swallowing.
While often not life-threatening, untreated or large hernias can worsen and may require surgery.
Understanding what a hiatus hernia is helps guide treatment decisions — whether lifestyle management or surgical repair.
Types of Hiatus Hernias
Hiatus hernias are mainly of two types — Sliding and Paraesophageal.
Sliding Hiatus Hernia
The most common type
The stomach and lower esophagus slide up into the chest through the hiatus
The movement can be intermittent and linked to posture or abdominal pressure
Often associated with GERD (acid reflux)
Symptoms: Heartburn, regurgitation, and discomfort after meals.
Treatment: Usually managed with medication and lifestyle changes; surgery is considered if symptoms persist.
Paraesophageal Hiatus Hernia
Less common but more serious
Part of the stomach pushes through the hiatus and sits beside the esophagus
Risk of strangulation (cut-off blood supply to the stomach)
Symptoms: Difficulty swallowing, chest pain, or fullness after meals.
Treatment: Often requires surgical repair even with mild symptoms.
Causes and Risk Factors
What Causes a Hiatus Hernia?
A hiatus hernia develops when the diaphragm muscles weaken, allowing the stomach to move upward.
Common causes include:
Aging and loss of muscle tone
Increased abdominal pressure (from obesity or pregnancy)
Heavy lifting or straining
Chronic coughing or vomiting
Genetic predisposition or congenital weakness
Trauma to the chest or abdomen
Often, it’s a combination of factors rather than a single cause.
Risk Factors You Should Know
You’re more likely to develop a hiatus hernia if you have:
Age: Over 50
Obesity: Extra pressure on the abdomen
Pregnancy: Hormonal and physical pressure
Smoking: Weakens the diaphragm and worsens reflux
Prior surgeries or injuries: Can alter diaphragm structure
While some factors (like age) can’t be controlled, maintaining healthy weight and quitting smoking can lower risk.
Symptoms and Diagnosis
Common Symptoms of a Hiatus Hernia
Symptoms often resemble other digestive issues, which is why many cases go undiagnosed.
Typical signs include:
Heartburn after meals or lying down
Regurgitation of acid into the throat
Difficulty swallowing (dysphagia)
Chest pain (sometimes mistaken for heart trouble)
Bloating and excessive burping
Shortness of breath if large hernia presses on lungs
Not everyone has all symptoms — some cases are silent and found during imaging for other conditions.
How is a Hiatus Hernia Diagnosed?
If suspected, your doctor may recommend:
Barium Swallow X-ray: Outlines the hernia’s size and type
Upper Endoscopy (EGD): Direct visualization of esophagus and stomach
Esophageal Manometry: Measures esophageal pressure and movement
pH Monitoring: Detects acid reflux severity
A combination of tests gives a complete picture, helping tailor treatment effectively.
Treatment Options
Lifestyle and Dietary Changes
Before medication or surgery, doctors recommend adjustments that can ease symptoms and prevent worsening.
Effective changes include:
Eat smaller, frequent meals
Avoid spicy, fatty, or acidic foods
Don’t lie down for 2–3 hours after eating
Elevate your head while sleeping
Lose excess weight
Quit smoking
Avoid tight clothing
Small changes can bring significant relief and even eliminate the need for medication.
Medications for Hiatus Hernia
When lifestyle adjustments aren’t enough, medications help manage acid reflux and inflammation.
Common medications include:
Antacids: Quick relief from acid (Tums, Rolaids)
H2 Blockers: Reduce acid production (Ranitidine, Famotidine)
PPIs: Block acid at the source (Omeprazole, Lansoprazole)
Prokinetics: Help move food faster and strengthen LES
Use these under medical supervision — long-term use of some (like PPIs) has side effects.
When is Surgery Needed?
Surgery is required when:
Symptoms are severe or unresponsive to treatment
Large paraesophageal hernia poses strangulation risk
Chronic GERD complications like Barrett’s esophagus occur
There’s difficulty swallowing or obstruction
Bleeding ulcers or anemia develop
The surgical goal is to reposition the stomach, tighten the diaphragm opening, and reinforce the LES to prevent reflux.
Hiatus Hernia Repair Surgery Explained
Types of Surgical Procedures
Laparoscopic Nissen Fundoplication
The most common minimally invasive method
Involves 4–5 small incisions
The stomach is pulled back down, and the hiatus is tightened
The stomach’s upper part (fundus) is wrapped around the esophagus to prevent reflux
Duration: 1–2 hours
Recovery: Most patients go home within 1–2 days with long-term relief.
Open Surgery
Used in complex or large hernias, or if prior surgeries complicate laparoscopy.
Requires a larger incision and longer recovery, but ensures thorough repair when needed.
How to Prepare for Surgery
Preparation Checklist:
Complete medical evaluation (blood tests, imaging)
Review medications (pause blood thinners if advised)
Fasting 8 hours before surgery
Quit smoking weeks in advance
Arrange help for post-surgery support
Understanding the process beforehand can ease anxiety and help you recover faster.
The Surgical Procedure
Step-by-Step Overview
General anesthesia is administered
Small incisions made (for laparoscopic surgery)
Stomach is repositioned into the abdomen
Hiatus opening is tightened
Fundoplication wrap performed
Incisions closed with sutures or glue
Duration: Around 1–2 hours
Monitoring: Post-op observation for pain, nausea, or breathing issues.
Anesthesia and Hospital Stay
Performed under general anesthesia
Laparoscopic: 24–48-hour stay
Open: 3–5 days stay
Full recovery: 4–6 weeks
Discharge only after ensuring you can eat, move, and manage pain comfortably.
Recovery After Hiatus Hernia Surgery
Post-Surgery Care Tips
Pain Management: Mild pain is normal; take prescribed medication
Wound Care: Keep area clean and dry
Avoid heavy lifting (3–5 kg) for 3 months
Walk regularly to improve healing and digestion
Follow-up visits to monitor recovery
Diet After Surgery
Stage 1 – Clear Liquids (Day 1–2)
Broth, clear juices, water, gelatin
Stage 2 – Full Liquids (Day 3–5)
Smooth soups, milk, pudding, protein shakes
Stage 3 – Soft Foods (Week 1–2)
Mashed potatoes, scrambled eggs, cooked veggies, soft fish
Stage 4 – Normal Foods (Week 3 onward)
Reintroduce regular foods gradually; avoid gas-producing or hard foods.
Eat slowly and chew thoroughly.
Physical Activity and Restrictions
Start light walking early, avoid:
Heavy lifting
Strenuous exercise
Bending or twisting
Driving while on pain meds
Gradually increase activity after 6–8 weeks with your doctor’s approval.
Risks and Complications
Common Short-Term Effects
Sore throat (from breathing tube)
Mild nausea or bloating
Shoulder pain (from gas used during laparoscopy)
Temporary swallowing difficulty
Possible Long-Term Complications
Hernia recurrence
Wrap migration or loosening
Chronic dysphagia
Gas-bloat syndrome
Rare: Dumping syndrome (rapid food movement causing nausea or dizziness)
Maintaining healthy habits post-surgery significantly lowers recurrence risk.
Follow-Up and Long-Term Care
Regular follow-ups ensure your repair remains intact and digestion stable.
With proper care, most patients enjoy complete symptom relief and long-term digestive comfort.