A hiatal hernia occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.

In most cases, a small hiatal hernia doesn't cause problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn. Self-care measures or medications can usually relieve these symptoms, although a very large hiatal hernia sometimes requires surgery.

Small hiatal hernias

Most small hiatal hernias cause no signs or symptoms.

Large hiatal hernias

Larger hiatal hernias can cause signs and symptoms such as:

  • Heartburn
  • Belching
  • Difficulty swallowing
  • Fatigue

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

A hiatal hernia occurs when weakened muscle tissue allows your stomach to bulge up through your diaphragm. It's not always clear why this happens, but pressure on your stomach may contribute to the formation of hiatal hernia.

How a hiatal hernia forms

Your diaphragm is a large dome-shaped muscle that separates your chest cavity from your abdomen. Normally, your esophagus passes into your stomach through an opening in the diaphragm called the hiatus. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak, and the upper part of your stomach bulges up through the diaphragm into your chest cavity.

Possible causes of hiatal hernia

Hiatal hernia could be caused by:

  • Injury to the area
  • Being born with an unusually large hiatus
  • Persistent and intense pressure on the surrounding muscles, such as when coughing, vomiting, or straining during a bowel movement or while lifting heavy objects

Hiatal hernia is most common in people who are:

  • Age 50 or older
  • Obese

Whom to see

Make an appointment with your family doctor or a general practitioner if you have signs or symptoms that worry you.

If you've been diagnosed with a hiatal hernia and are experiencing signs and symptoms that aren't controlled with medications and lifestyle changes, ask your doctor for a referral to a doctor who specializes in digestive diseases (gastroenterologist).

How to prepare

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. To get ready, try to:

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Consider taking a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Questions to ask

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For hiatal hernia, some basic questions to ask your doctor include:

  • What caused my hiatal hernia?
  • Will I need treatment for my hiatal hernia?
  • Do I need more tests?
  • What are my treatment options?
  • What are the benefits and risks of each option?
  • I have these other health conditions. How can I best manage them along with my hiatal hernia?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Is there a generic alternative to the medicine you're prescribing for me?
  • Are there brochures or other printed material that I can take with me? What websites do you recommend?
  • What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

A hiatal hernia is often discovered during a test or procedure to determine the cause of heartburn or chest or upper abdominal pain. Such tests or procedures include:

  • An X-ray of your upper digestive tract. During a barium X-ray, you drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray.
  • Using a scope to see inside your digestive tract. During an endoscopy exam, your doctor passes a thin, flexible tube equipped with a light and video camera (endoscope) down your throat and into your esophagus and stomach to check for inflammation.

Most people with hiatal hernia don't experience any signs or symptoms and won't need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.

Medications for heartburn

If you experience heartburn and acid reflux, your doctor may recommend medications, such as:

  • Antacids that neutralize stomach acid. Over-the-counter antacids, such as Gelusil, Maalox, Mylanta, Rolaids and Tums, may provide quick relief.
  • Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75). Stronger versions of these medications are available in prescription form.
  • Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Stronger versions of these medications are available in prescription form.

Surgery to repair a hiatal hernia

In a small number of cases, a hiatal hernia may require surgery. Surgery is generally reserved for emergency situations and for people who aren't helped by medications to relieve heartburn and acid reflux. Hiatal hernia repair surgery is often combined with surgery for gastroesophageal reflux disease.

An operation for a hiatal hernia may involve pulling your stomach down into your abdomen and making the opening in your diaphragm smaller, reconstructing a weak esophageal sphincter, or removing the hernia sac. In some cases, this is done using a single incision in your chest wall (thoracotomy) or abdomen (laparotomy). In other cases, your surgeon may insert a tiny camera and special surgical tools through several small incisions in your abdomen. The operation is then performed while your surgeon views images from inside your body that are displayed on a video monitor (laparoscopic surgery).

Lifestyle changes may help control the signs and symptoms of acid reflux caused by a hiatal hernia. Consider trying to:

  • Eat several smaller meals throughout the day rather than a few large meals.
  • Avoid foods that trigger heartburn, such as chocolate, onions, spicy foods, citrus fruits and tomato-based foods.
  • Avoid alcohol.
  • Eat at least two hours before bedtime.
  • Lose weight if you're overweight or obese.
  • Stop smoking.
  • Elevate the head of your bed 6 inches (about 15 centimeters).

Some alternative medicine practitioners claim to have discovered a way to cure a hiatal hernia by pushing the stomach back to its normal position below the diaphragm. Practitioners may use their hands to apply pressure to the abdomen and manipulate the stomach.

There's no evidence that such manipulation works to cure hiatal hernia. No clinical trials of the technique have been conducted.

  • Experience. Each year, Mayo Clinic specialists treat more than 10,000 people with hiatal hernias (also known as diaphragmatic hernias). Mayo surgeons specialize in repairing hernias in the esophagus and chest.
  • Comprehensive, efficient testing. Mayo Clinic offers all testing options to determine if a hiatal hernia is causing your symptoms. Testing can be completed in a few days, and your doctor will have the results quickly, so that treatment can be started promptly.
  • Team approach. Mayo Clinic's teamwork system brings together the doctors you need to treat your problem — digestive specialists (gastroenterologists), imaging specialists (radiologists), and chest (thoracic) and abdominal surgeons. All three Mayo Clinic locations have special esophageal clinics to coordinate care for people with hiatal hernia.
  • Mayo Clinic in Rochester, Minn., ranks No. 1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked high performing for digestive disorders by U.S. News & World Report.

    At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

    Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

    Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.

    Why Choose Mayo Clinic

    What Sets Mayo Clinic Apart

    Diagnosis of a hiatal hernia begins with a thorough review of your medical history and a physical exam. Mayo Clinic offers the latest diagnostic testing options. Test results are typically available on the same day or within 24 hours. Efficient testing helps the team quickly arrive at a diagnosis, so your treatment can begin as soon as possible. Mayo's experience helps doctors recognize hiatal hernias or other possible causes of your symptoms.

    Among the tests used to diagnose a hiatal hernia are:

    • Esophagram (barium swallow). An X-ray visualizes movement of liquids through the esophagus when you swallow.
    • Endoscopy. A flexible, narrow tube (endoscope) with a camera is passed into the esophagus to view the inside of the throat (pharynx) and esophagus.
    • pH probe. A thin tube is passed into the esophagus to determine if stomach acids are entering your esophagus (acid reflux).
    • Esophageal motility testing. Monitors are passed down a thin tube inserted into the esophagus to determine the strength and coordination of your swallow.
    • Capsule pH test. A small capsule is temporarily attached to the lower end of your esophagus during an endoscopy. The capsule records the amount of time stomach acid refluxes back into your esophagus and whether your heartburn occurs during an actual instance of acid reflux. Information from the capsule is transmitted to a pager-like receiver.

    In most cases, small hernias do not cause symptoms or require treatment. A large hernia may require treatment with medications or surgery.

    Surgery

    For people with a large hiatal hernia, repair surgery is sometimes the best option when medications and lifestyle changes have been ineffective. Repair surgery initially involves pulling your stomach down into your abdomen (reduction) and can be combined with other surgeries such as those for gastroesophageal reflux disease (GERD). Based on the cause of your symptoms, your doctor may recommend one of the following additional surgical options after reduction.

  • Fundoplication. The top part of the stomach is wrapped around the bottom part of the esophagus to strengthen it. The defect in the diaphragm also is closed.
  • Gastropexy. The stomach is attached to the abdominal wall, if it moves around easily after reduction.
  • Esophagectomy. The surgeon removes most of your esophagus and attaches your stomach to the remaining portion.
  • Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

    Specialists in gastroenterology and thoracic surgery work together to care for adults who have a hiatal hernia. A special Esophageal Clinic helps coordinate care of people with esophageal disorders.

    For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

    Specialists in gastroenterology and thoracic surgery work together to identify the appropriate treatment approach for adults who have a hiatal hernia. A special Esophageal Clinic helps coordinate care of people with esophageal disorders.

    For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

    Specialists in gastroenterology and thoracic surgery work together to diagnose and treat adults and children who have a hiatal hernia. Specialists interested in diseases of the esophagus participate in an Esophageal Interest Group, and an Esophageal Clinic helps coordinate care of people with esophageal diseases.

    For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

    See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

    Publications

    See a list of publications by Mayo Clinic doctors on hiatal hernia on PubMed, a service of the National Library of Medicine.

    Dec. 08, 2011