Amy Scholten, MPH
A hiatal hernia is a movement of part of the stomach up into the chest cavity. The stomach presses up through a small hole in the diaphragm muscle. The diaphragm is the muscular wall that separates the abdominal cavity from the chest cavity.
Different types of hiatal hernias include:
The exact cause of hiatal hernias is not clear. Some people are born with a hiatal hernia but others will develop it later in life.
The diaphragm has an opening that the esophagus can pass through. A weakening or injury to this opening can allow a hiatal hernia to develop. Increased pressure in the abdomen can also push the stomach up into the chest cavity.
Hiatal hernias are more common in adults over 50 years of age. Other factors that increase your chance of getting hiatal hernia include:
Most people with hiatal hernias have no symptoms.
A hiatal hernia can make stomach acid moves up into the esophagus. This is known as
gastroesophageal reflux disease
(GERD). Symptoms of GERD can include:
You will be asked about your symptoms and medical history. A physical exam will be done. Because they often have no symptoms, hiatal hernias are sometimes only detected during a visit to the doctor for other reasons.
Images may be taken of your stomach. This can be done with an upper gastrointestinal series or upper gastrointestinal endoscopy.
Talk with your doctor about the best treatment plan for you. Hiatal hernias are usually treated only when there are symptoms. When GERD is present, treatment may include one or more of the following:
For people who are obese, losing weight may relieve symptoms.
Avoid foods that relax the lower esophageal sphincter (LES), a muscle that controls the opening between the esophagus and the stomach, including:
Avoid foods and beverages that can irritate the internal lining of the esophagus, such as:
To minimize acid reflux:
If you smoke, talk to your doctor about ways to quit. Smoking weakens the LES.
Elevating the head of the bed on blocks or sleeping on a specially designed wedge reduces heartburn. This position helps prevent stomach contents from refluxing backward into the esophagus.
Your doctor may recommend over-the-counter antacids. These can neutralize acid and temporarily relieve heartburn.
For chronic reflux and heartburn, several types of medications may be prescribed to reduce acid in the stomach. These include H-2 blocker and proton pump inhibitors.
Surgery may be needed if:
There are no current guidelines to prevent a hiatal hernia because the cause is unknown.
American College of Gastroenterology
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Medical Association
Gastroesophageal reflux disease. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 11, 2016. Accessed September 28, 2016.
Gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/ger-and-gerd-in-adults/Pages/overview.aspx. Accessed January 14, 2015.
Hiatal hernia. EBSCO DynaMed Plus website. Available at:
http://www.dynamed.com/topics/dmp~AN~T116557/Hiatal-hernia. Updated October 27, 2014. Accessed September 28, 2016.
Hiatus hernia. Merck Manual Professional Verson website. Available at:
http://www.merckmanuals.com/professional/gastrointestinal_disorders/esophageal_and_swallowing_disorders/hiatus_hernia.html. Updated May 2014. Accessed January 14, 2015.
Last reviewed March 2016 by Marcin Chwistek, MD
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