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Hiatus herniaPublished by Bupa's health information team, December 2007. This factsheet is for people who have a hiatus hernia, or who would like information about it. A hiatus hernia is when part of the stomach slides through the diaphragm into your chest. Hiatus hernias are common in people over 50. Often they won't cause any problems, but can give you pain and heartburn.
About hiatus herniaNormally, the stomach is completely below your diaphragm - the muscular sheet that separates the abdomen from the chest cavity where your lungs sit (see illustration).
The weakest part of the diaphragm is the opening through which your oesophagus (the pipe that goes from your mouth to your stomach) passes. A hiatus hernia forms when part of the stomach slides through this opening (hiatus) and into your chest cavity. There are two main types of hiatus hernia. Sliding hiatus herniaThis is the most common type, affecting eight in 10 people with a hiatus hernia. The hernia occurs when the top part of the stomach, called the gastro-oesophageal sphincter, slides up through the diaphragm. How sliding hiatus hernias form animation Rolling hiatus herniaThis type affects only about two in 10 people with a hiatus hernia. It involves part of the stomach bulging up through the opening in the diaphragm, while the gastro-oesophageal sphincter stays below it. It is also sometimes called a para-oesophageal hernia. How rolling hiatus hernias form animation SymptomsOften, a hiatus hernia won't cause you any symptoms. However, it may cause a feeling of warmth or burning in your chest, which is called heartburn. This happens when the contents of your stomach, which are acidic, flow backwards (reflux) into your oesophagus. If heartburn symptoms go on for a long time or are severe, this is called gastro-oesophageal reflux disease (GORD). The irritation to your oesophagus caused by reflux can cause pain or discomfort behind your breastbone (sternum). Your symptoms may start or get worse after you have eaten, soon after you lie down or when you bend forward. Drinking coffee or other hot drinks, or eating spicy food can make these symptoms worse. Although not necessarily a result of hiatus hernia, if you have these symptoms you should visit your GP. ComplicationsOccasionally, a hiatus hernia can lead to more serious problems. Unlike the stomach, the lining of the oesophagus isn't designed to withstand acid. Reflux of the acidic stomach contents into the oesophagus can damage the lower end of the oesophagus. This is made more likely by a hiatus hernia and can damage the lower end of the oesophagus. This makes symptoms worse and can lead to the formation of ulcers (breaks in the lining of the oesophagus). If your ulcers bleed, you may vomit blood. You should seek urgent medical treatment if you ever see blood in your vomit. A bleeding ulcer can also lead to anaemia, a condition when you have too few red blood cells or not enough oxygen-carrying haemoglobin in your blood. In the longer term, when ulcers have healed they can lead to narrowing (stricture) of the oesophagus, which can cause difficult, painful swallowing and regurgitation of food. The blood supply to the stomach can also be affected if a segment of the stomach gets tightly trapped in the chest area; this is known as strangulated hernia. With rolling hiatus hernia, the stomach can become blocked, leading to pain and vomiting. CausesThe exact cause of hiatus hernia isn't known. However, hernias tend to happen when there is some stretching of the tough fibres that normally hold the gastro-oesophageal sphincter in place. The muscles of the diaphragm may also become more flexible. Both of these probably occur with increasing age. About one in three people over 50 will have a small hiatus hernia, probably without symptoms. Anything that increases the pressure inside the abdomen can increase the size of the hernia. Factors that increase the abdominal pressure include:
DiagnosisYour GP will ask about your symptoms and examine you. He or she may also ask about your medical history. You may be referred to a gastroenterologist - a doctor specialising in the digestive system - for tests, which may include the following.
You may also be asked for a sample of blood to check for anaemia, which can be a sign of blood loss. TreatmentSelf-helpYou can reduce the symptoms of your sliding hiatus hernia and prevent it causing you more problems by making these lifestyle changes:
Over-the-counter medicinesAntacidsAntacids can be taken in either in liquid or tablet form. Those containing magnesium or aluminium generally work by neutralising the stomach acid. Others contain an ingredient called an alginate, which forms a barrier that floats on the top of the stomach contents and prevents them splashing back up into the oesophagus. Many of the antacids contain a mixture of ingredients. Examples of antacid brands include Rennies and Gaviscon. Acid-blocking medicinesIf antacids don't work for you, or you need to take large quantities to get relief, your doctor or pharmacist may recommend one of the more powerful acid-blocking medicines. H2 blockers are one type of over-the-counter medicines that cut the amount of acid that the stomach produces. Examples are famotidine (Pepcid Two) and ranitidine (Zantac). Another type of medicine, known as a proton-pump inhibitor, completely stops acid production. An example is omeprazole (Zanprol). Prescription-only medicinesIf you need to take medicines for indigestion regularly, more than two or three times a week for example, you should discuss your symptoms with a doctor. Your doctor can prescribe regular H2 blockers or proton pump inhibitors in higher doses than are available without a prescription. SurgeryRarely, a sliding hiatus hernia causes such severe symptoms or complications that your doctor will recommend surgery. If you have a rolling hiatus hernia, you are more likely to need surgery. Surgery involves pushing the stomach back into the correct position and securing it there, before repairing any gap in the diaphragm. The procedure can usually be done by keyhole surgery although open surgery (through a cut in the abdomen) is sometimes needed. Further information
Sources
Related topicsThis information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: December 2007. Expected review date: December 2009.
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