Hiatal Hernia: Upper Digestive Tract Disorder

The esophagus passes through a small opening in the diaphragm, which separates the chest cavity from the abdominal cavity. Normally, the lower esophageal sphincter at the bottom of the esophagus is aligned with this opening in the diaphragm (the hiatus). The rest of the esophagus is located above the diaphragm in the chest cavity, and the stomach is located below the diaphragm in the abdominal cavity.

If you are one of the 25% of people over age 50 who have a hiatal hernia, your lower esophageal sphincter and a small portion of your stomach have slipped through the opening in the diaphragm and are now protruding into your chest cavity.

The resulting separation between the lower esophageal sphincter and the diaphragm weakens the barrier against reflux of acid from the stomach into the esophagus, increasing the risk of GERD and erosive esophagitis (damage to the lining of the esophagus).

Causes of hiatal hernia

A hiatal hernia can be congenital, meaning that you are born with it. It can develop later in life, as the result of either a weakening of the muscle that surrounds the opening of the diaphragm or a rise in pressure in the abdominal cavity.

Risk factors for a hiatal hernia include being overweight and lifting heavy objects.

Symptoms of hiatal hernia

Most hiatal hernias produce no symptoms and are found by chance during tests for other health problems. However, when the lower esophageal sphincter is significantly displaced from its normal position in the hiatus, reflux symptoms (such as heartburn) can occur.

Diagnosis and treatment of hiatal hernia

Hiatal hernias are diagnosed by an upper GI series or an upper endoscopy. If a hiatal hernia is not causing symptoms, treatment isn't needed. When symptoms such as recurrent heartburn arise, they can often be relieved with lifestyle measures and medication.

If the hiatal hernia is causing severe reflux, it can be repaired surgically by pulling the stomach back into the abdominal cavity and repairing the defect in the diaphragm that allowed the stomach to slip into the chest cavity.

To prevent future slippage and to strengthen the lower esophageal sphincter, the surgeon may also perform a Nissen fundoplication, in which the top portion of the stomach is wrapped around the bottom of the lower esophageal sphincter.

Publication Review By: H. Franklin Herlong, M.D.

Published: 23 Mar 2011

Last Modified: 11 Jul 2012