Hiatus hernia

A hernia is when your organs or body tissues push through a gap in a muscle or tissue, getting into a space where it doesn't normally sit.

In a hiatus hernia (also known as a hiatal hernia), part of your stomach pushes through a gap in the diaphragm into your chest. It moves into the space in your chest. The diaphragm is a large, flat muscle that separates your chest from your abdomen and is important for breathing.

Normally, your stomach sits below the diaphragm, and a muscle (sphincter) keeps your oesophagus (food pipe) closed. This stops your stomach contents from coming back up (regurgitation or reflux).

Hiatus hernias are classified into different types, depending on which part of the stomach pushes up through your diaphragm:

• Sliding hiatus hernia — this is the most common type. The upper part of the stomach connected to the oesophagus slides into your chest through the diaphragm.
• Paraesophageal hernia — a lower part of the stomach (that is not connected to the oesophagus) moves into your chest.

You can have a combination of a sliding hiatus hernia and paraesophageal hernia, where both the upper and lower parts of the stomach move into your chest.

It's also possible for part of another abdominal organ to push through the diaphragm, for example, the small bowel.

Many people with a hiatus hernia have no symptoms.

A hiatus hernia can cause food and acid to move from the stomach back up the oesophagus. This is known as gastroesophageal reflux disease (GORD), 'reflux' or heartburn.

Other symptoms of hiatus hernia may include:

• chest or abdominal pain
• shortness of breath
• coughing
• difficulty swallowing
• vomiting
• bad breath or gum problems, due to reflux

It's not always clear what causes a hiatus hernia. It may be caused by a weakness in the opening in the diaphragm that allows a part of the stomach to slide up through the diaphragm.

Risk factors that increase your chance of developing a hiatus hernia include:

• being over 50 years of age
• muscle weakness affecting your abdomen or diaphragm
• living with obesity
• excessive straining — for example frequent coughing, weightlifting or straining to pass bowel motions
• being born with a large gap in your diaphragm

You should see your doctor if you have symptoms of a hiatus hernia. Early diagnosis and treatment can help manage your symptoms. You should also see your doctor if:

• your symptoms are getting worse
• over-the-counter medicines aren't controlling your symptoms
• you are vomiting frequently

If you have any of the symptoms below, call triple zero (000) immediately and ask for an ambulance.

• severe abdominal pain — this may signal a serious issue such as a twisted or trapped bowel
• severe chest pain
• shortness of breath

Your doctor will review your medical history and perform a physical examination.

Your doctor may also refer you for tests such as:

• imaging tests including x-ray, CT or ultrasound
• endoscopy — where a camera is used to look inside your oesophagus and stomach
• manometry — a test to check the muscles of your oesophagus
• pH check — a test that measures the acid production in your oesophagus over 24 hours

The treatment depends on the type of hernia and whether your symptoms are significant.

Treatments may include:

• Medicines — such as proton pump inhibitors (PPIs), that are used to reduce the amount of stomach acid produced. These are often the first treatment for symptoms of GORD.
• Surgery — you may need surgery if medicines don't help or if there is damage to your oesophagus. There are different types of surgery, including anti-reflux surgery or a large hiatus hernia surgery.
• Emergency surgery — may be needed for a paraesophageal hernia, which can cause the stomach to twist. This is a medical emergency that needs urgent treatment.

If you have symptoms of GORD caused by a hiatus hernia, you can reduce or relieve your symptoms by:

• Following medicine instructions — use medicines as suggested by your doctor.
• Avoiding excessive abdominal pressure — avoid straining while on the toilet, and weightlifting.
• Adjusting your position — sitting upright or elevating the head of your bed may reduce your symptoms.

You can buy antacids over the counter to neutralise stomach acid and relieve your symptoms. Talk to your pharmacist or doctor about what medicines may be suitable for you.

Lifestyle changes that may also help include:

• avoiding certainfoods and drinks — such as fatty or spicy foods that can cause reflux
• eating smaller meals
• losing weight if needed
• quitting smoking

An untreated hiatus hernia can cause problems including:

• Strangulated hernia — this happens when the hernia cuts off the blood supply to part of the stomach.
• Bowel obstruction — when the hernia blocks the digestive system, making it difficult or impossible for food and gas to pass through.
• GORD — this is when stomach acid flows back up your oesophagus. It can cause heartburn and damage your oesophagus.
• Esophagitis — this is the inflammation of the oesophagus due to acid reflux. It can lead to bleeding or ulcers in the oesophagus.
• Barrett's oesophagus — this condition changes the tissue lining the oesophagus. It can increase your risk of developing oesophageal cancer.

You are less likely to develop a hiatus hernia if you maintain a healthy weight and if you avoid straining your abdomen.

You can find out more about hiatus hernia from The Gut Foundation.

If you're going to have surgery, it's good to be prepared. healthdirect offers information on how to prepare for a surgery and provide tips on questions to ask before the surgery.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.