Hiatus Hernia

What is hiatus hernia?

Hiatus hernia occurs when part of the stomach pushes up through the opening in the diaphragm (the hiatus) into the chest cavity. The NHS describes it as very common in adults over 50 and notes that many people have no symptoms and need no treatment.

The NICE CG184 guideline on gastro-oesophageal reflux disease and dyspepsia in adults recognises hiatus hernia as a factor that can contribute to reflux symptoms, while making clear that not everyone with a hiatus hernia experiences heartburn or regurgitation.

Types

• Sliding hiatus hernia — the stomach and the lower oesophageal sphincter slide up into the chest. This is the most common type.
• Para-oesophageal (rolling) hiatus hernia — part of the stomach pushes up next to the oesophagus while the sphincter stays in place. This type carries a higher risk of complications such as strangulation or obstruction and may require closer monitoring.

How it is diagnosed

Diagnosis is typically made by:

• Endoscopy (gastroscopy) — a camera examination of the upper digestive tract.
• Barium swallow — X-ray imaging after swallowing a contrast liquid that shows the outline of the oesophagus and stomach.

Sometimes a hiatus hernia is found incidentally during investigation for other symptoms.

Common symptoms

Many hiatus hernias cause no symptoms at all. When symptoms do occur, they can include:

• Heartburn or acid reflux
• Regurgitation of food or acid
• Chest pain or discomfort
• Difficulty swallowing
• Bloating or belching
• Bad breath

Symptoms often overlap with gastro-oesophageal reflux disease (GERD), but a hiatus hernia can exist without reflux and reflux can exist without a hiatus hernia.

Common patterns

• More common with increasing age, particularly over 50.
• Obesity and pregnancy can increase pressure on the abdomen and raise risk.
• Symptoms may worsen after large meals or when lying down.
• Many people live with a hiatus hernia unaware of it.