The diaphragm is a muscle which separates the chest cavity from the abdomen. A hiatal hernia is a weakness in the diaphragm through which the upper part of the stomach protrudes into the chest. The hiatal hernia usually lies in the area where the oesophagus travels through the diaphragm. Patients with a hiatal hernia often suffer regurgitation of stomach acid (reflux) into the oesophagus. This can result in reflux disease with oesophageal inflammation.
A congenital connective tissue weakness is usually the cause of a hiatal hernia. The point of passage of the oesophagus through the diaphragm is extended as a result of the connective tissue weakness. This can result in the stomach shifting into the chest. This process is facilitated through increased pressure in the abdomen. For example, coughing, chronic constipation with severe straining during a bowel movement or in the case of excessive weight.
A hiatal hernia often remains unnoticed as it often causes few or no symptoms at all. If there are symptoms, they are generally heartburn, acid regurgitation and indigestion due to the reflux of stomach acid into the oesophagus. The symptoms occur characteristically while the patient is lying down, and improve when they sit up. In very rare cases, this can lead to a constriction of the stomach, which is connected with extreme pain and gagging. Such symptoms should therefore be clarified by a doctor.
A hiatal hernia is usually diagnosed with a Gastroscopy. Sometimes other examinations such as a contrast agent x-ray are required.
The treatment depends on extent of the symptoms and how severe the hiatal hernia is. Acid-inhibiting medication is used to combat acid reflux. This treatment is fully symptomatic and the hiatal hernia is thus remedied. A definitive cure is only possible with surgery. If there is a constriction of the stomach or a risk of constriction occurring, surgery is therefore usually inevitable. Find out more on the surgery in the Reflux surgery section.