Hiatal Hernias

A hiatal hernia occurs when the upper part of the stomach pushes through a small opening in the diaphragm (hiatus) and enters the chest. Hiatal hernias are common, affecting 15-20% of the population in the United States.

About Hiatal Hernias

Your diaphragm is a large muscle that separates your abdomen (stomach) from your chest. A hiatal hernia occurs when weakened muscle tissues allows the upper part of your stomach to push through an opening in your diaphragm (hiatus) and enter your chest. Hiatal hernias, particularly larger ones (greater than 5 cm), can become quite serious and require surgical intervention. The only way to reduce a hiatal hernia is through surgical intervention.

Causes of Hiatal Hernias

The cause of hiatal hernias remains unknown. However, hiatal hernias are thought to arise from age-related changes in your diaphragm, being born with an unusually large hiatus, an injury to the area after trauma or certain forms of surgery, or persistent and intense pressure on the surrounding muscles, such as experienced when coughing, exercising, lifting heavy objects, straining during a bowel movement, or vomiting.

Symptoms of Hiatal Hernias

Unlike larger hiatal hernias, small hiatal hernias typically do not cause any signs or symptoms.

Symptoms of hiatal hernias may include:

• Abdominal pain
• Acid reflux (backflow of stomach acid into esophagus)
• Chest pain
• Difficulty swallowing (dysphagia)
• Dry cough
• Feeling full soon after eating
• Heartburn
• Indigestion
• Regurgitation of food or liquids into the mouth
• Shortness of breath
• Tooth decay
• Vomiting of blood or passing of black stools (gastrointestinal bleeding)

Risk Factors for Hiatal Hernias

Hiatal hernias are more common among people over the age of 50, though they can occur at any age.

Other common risk factors for hiatal hernias include:

• Obesity
• Pregnancy
• Smoking

Diagnosing Hiatal Hernias

Hiatal hernias are diagnosed by performing a barium swallow, also known as an esophagogram, which is a specialized x-ray study (fluoroscopy) that allows visualization of the esophagus and stomach. To perform a barium swallow, the patient must swallow a chalky white substance (barium) that coats the inside of the upper gastrointestinal (GI) track, which includes the esophagus, stomach, and duodenum (the first part of the small intestine). Barium absorbs x-rays, causing the organs, inside linings of the upper GI tract, and motion of swallowing to appear white on x-ray film. Hiatal hernias can also be diagnosed by performing an upper endoscopy, which involves inserting a long, thin, flexible tube (endoscope) with a tiny camera on the end down the esophagus. Performing a barium swallow or endoscopy allows your doctor to examine and diagnose any disorders of the upper GI track.

Treating Hiatal Hernias

Most small hernias (often less than 3 cm) can be managed with medication of lifestyle changes. Larger hernias may require surgical intervention. If needed, surgery is performed laparoscopically in which short, narrow tubes (trocars) are inserted into the abdomen through small (less than 1 cm) incisions. Long, narrow instruments are inserted into the trocars and used to manipulate, cut, and sew tissue. Evidence shows that digestive health specialists who specialize in conditions of the foregut experience better patient outcomes.

Care Team Approach

Digestive Health, a clinical partnership between Ascension Seton and UT Health Austin, takes a multidisciplinary approach to your care. This means you will benefit from the expertise of multiple specialists across a variety of disciplines. Your care team will include gastroenterologists, surgical and non-surgical heartburn and esophageal disorders specialists, physician assistants, nurses, advanced practice providers, dietitians, social workers, and more, providing unparalleled care for patients every step of the way. We collaborate with our colleagues at the Dell Medical School and The University of Texas at Austin to utilize the latest research, diagnostic, and treatment techniques, allowing us to identify new therapies to improve treatment outcomes. We are committed to communicating and coordinating your care with your other healthcare providers to ensure that we are providing you with comprehensive, whole-person care.

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