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Hiatal Hernia

A hernia occurs when an internal body part pushes through an opening into an area of the body where it does not belong. In a hiatal hernia, part of the upper stomach bulges through the hiatus—the opening in the diaphragm between the chest and the abdomen through which the esophagus passes.

Some people are born with a larger hiatus, increasing their risk of developing a hiatal hernia. In other cases, the hernia may be caused by pressure in the abdomen created by pregnancy, obesity, coughing, or straining during bowel movements. Being older and smoking are other risk factors. In most cases, the cause of a hiatal hernia is not known.

Types of Hiatal Hernias

There are two main types of hiatal hernias:

  • A sliding hiatal hernia is the more common type of hiatal hernia. The stomach and the part of the esophagus that joins the stomach slide up into the chest through the hiatus.
  • A paraesophageal hernia is less common, but more serious. In this type, part of the stomach bulges through the hiatus and ends up next to the esophagus. This type of hernia can cause the stomach to become strangled or to lose its blood supply, which is an emergency situation that requires immediate medical attention.



Hiatal hernias often cause no symptoms. When symptoms do appear, they may include:

  • Chest pain that may feel like a heart attack
  • Difficulty swallowing
  • Heartburn that increases when bending over or lying down. Some people with hiatal hernias also have gastroesophageal reflux disease (GERD).



If you show signs of having a hiatal hernia, the esophageal experts at Norton Thoracic Institute will assess your condition through several tests before recommending treatment. These tests may include:

  • Barium swallow. For this x-ray exam, you will drink a thick liquid called barium. The barium fills and coats the inside of the esophagus, allowing the physician to examine the hernia.
  • Upper endoscopy to examine the inside of your esophagus, stomach, and small intestine. In this procedure, a flexible tube called an endoscope with a light and camera is passed into your esophagus while you are lightly sedated. Tissue samples (biopsies) may be taken during this exam.



Treatment options depend on the type of hernia you have and the severity of your condition. Possible treatments include:

  • Medication to treat GERD, if present
  • Medication to strengthen the muscles in the lower esophagus so that the stomach’s contents don’t back up into the esophagus
  • Surgery if the hiatal hernia may cause constriction or strangulation of the stomach. In many cases, hiatal hernia surgery can be done laparoscopically. In this minimally invasive operation, the surgeon makes a few small incisions in the abdomen. The surgeon inserts a laparoscope through the incisions to see inside the abdomen and then uses tiny instruments to put any herniated tissue back where it belongs. Most patients return to their regular activities within a week of the procedure.



Not all hiatal hernias can be prevented, but you can reduce your risk of developing this condition by controlling your weight and refraining from smoking. If you have a hiatal hernia, take these steps to reduce symptoms and manage your condition:

  • Avoid heavy or large meals, especially at night.
  • Don’t bend over or lie down right after eating.
  • If you smoke, quit now.
  • Lose weight if you are overweight.
  • Raise the head of your bed 4-6 inches by putting blocks under the headboard or, preferably, a foam wedge under your mattress.

Learn More About Hiatal Hernia Services at Norton Thoracic Institute

To learn more about our services, call (602) 406-4000.