By Mayo Clinic Staff
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.
Most small hiatal hernias cause no signs or symptoms. However, larger hiatal hernias can cause signs and symptoms such as:
- Difficulty swallowing
- Chest or abdominal pain
- Feeling especially full after meals
- Vomiting blood or passing black stools, which may indicate gastrointestinal bleeding
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 and age-related changes in your diaphragm may contribute to the formation of a 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:
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 your problems persist after you make lifestyle changes and start medication, ask your primary doctor for a referral to a doctor who specializes in digestive diseases (gastroenterologist).
What you can do
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 doctor
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 a 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 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:
- Blood testing. Your doctor may recommend a complete blood count to check for anemia due to blood loss.
- An esophagram (barium swallow). During this procedure, 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.
- Endoscopy. 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.
- Manometry. During this test, a thin, pressure-sensitive tube (catheter) is passed through your nose, down through the esophagus and into the stomach. The catheter then measures pressure and movement inside the esophagus.
Most people with a 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, which are rare, and for people who aren't helped by medications to relieve heartburn and acid reflux.
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, surgery 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).
Making a few lifestyle changes may help control the signs and symptoms of acid reflux caused by a hiatal hernia.
- 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 to three 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.
- Mayo Clinic specialists have vast experience with hiatal hernias, treating more than 10,000 people each year. Mayo surgeons specialize in repairing hernias in the esophagus and chest.
Efficient, timely care at Mayo Clinic revolves around you and your needs. A detailed itinerary for appointments, tests and procedures allows you to make the most of your time at the clinic. Mayo Clinic specialists run all tests and labs themselves, which means tests taken in the morning can be reviewed the same afternoon.
Mayo's collaborative approach means two or three days often yields the same diagnosis and care insights that could take weeks in less coordinated institutions.
- Mayo Clinic's teamwork system brings together a wide range of specialists 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 doctors take the time to listen closely. Mayo doctors get to know you and your concerns completely, and explain your options in plain language. Through long experience, Mayo doctors have learned that understanding and considering all your issues is key to developing the most effective treatment plan.
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 among the Best Hospitals for digestive disorders by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for digestive disorders.
Mayo's experience helps doctors recognize hiatal hernias or other possible causes of your symptoms. Diagnosis of a hiatal hernia begins with a thorough review of your medical history and a physical exam. Mayo Clinic offers all standard diagnostic tests for hiatal hernia, including esophagography, endoscopy and manometry.
For people with symptoms of gastroesophageal reflux disease (GERD), Mayo Clinic offers a comprehensive evaluation to diagnose your condition, including pH capsule testing and 24-hour impedance pH testing.
During 24-hour impedance pH testing, your doctor places a thin, flexible catheter with an acid-sensitive and fluid-sensitive tip through your nose into your esophagus. Over the course of 24 hours, the catheter records the flow of liquid from your stomach into your esophagus.
This test has the advantage of measuring both acid and nonacid reflux and is typically used with people on maximal therapy for reflux. The results can help doctors design a course of treatment for you.
Results for all tests 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.
In most cases, small hernias do not cause symptoms or require treatment. 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). This surgery may be combined with other surgeries, such as those for gastroesophageal reflux disease (GERD) or weight-loss (bariatric).
Based on the cause of your symptoms, your doctor may recommend one of the following additional surgical options:
- 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 ligament of the diaphragm, if it moves around easily after reduction.
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.
- U.S. Patients
- International Patients
Specialists in gastroenterology and thoracic surgery work together to identify the appropriate treatment approach for adults who have a hiatal hernia.
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.
- U.S. Patients
- International Patients
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.
- U.S. Patients
- International Patients
See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.
See a list of publications by Mayo Clinic doctors on hiatal hernia on PubMed, a service of the National Library of Medicine.
Feb. 03, 2015
- Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Jan. 6, 2015.
- Kahrilas PJ. Hiatus hernia. http://www.uptodate.com/home. Accessed Jan. 7, 2015.
- Townsend CM Jr, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed Jan. 7, 2015.
- Yeo CJ. Shackelford's Surgery of the Alimentary Tract. 7th ed. Philadelphia, Pa.: Elsevier; 2013. https://www.clinicalkey.com. Accessed Jan. 7, 2015.
- Mahawar KK, et al. Simultaneous sleeve gastrectomy and hiatus hernia repair: A systematic review. Obesity Surgery. 2015;25:159.
- Katz PO, et al. Corrigendum: Guidelines for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology. 2013;108:308.
- Guidelines for the management of hiatal hernia. Society of American Gastrointestinal and Endoscopic Surgeons. http://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia/. Accessed Jan. 7, 2015.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. Sept. 26, 2014.
- Rakel D. Integrative Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Jan. 9, 2015.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 18, 2015.
- Rohren CH (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 10, 2015.