Hiatal Hernia - Causes, Diagnosis, Treatment, Complications
- Medically checked
Hiatal hernia occurs when the upper portion of the stomach pushes through the diaphragmatic opening (the hiatus) into the thoracic cavity. This opening normally allows the esophagus to connect with the stomach in the abdominal cavity.
Hiatal hernias are classified into the following types:
- Sliding Hernia – The esophagogastric junction slides up into the chest.
- Paraesophageal Hernia – A portion of the stomach herniates beside the esophagus.
- Mixed Hernia – A combination of sliding and paraesophageal hernias.
Learn more about hernias: Hernia – Types of hernias, symptoms, complications, treatment
The sliding type is most common. Although less frequent, paraesophageal hernias can lead to complications such as strangulation or digestive tract obstruction. Hiatal hernias may also be classified by size. Small hernias often remain asymptomatic, while larger hernias may allow gastric contents to reflux into the esophagus, causing discomfort.
What Are the Symptoms and Complications of Hiatal Hernia?
Many small hiatal hernias cause no symptoms. However, larger hernias can result in:
- Burning sensation in the stomach (pyrosis), worsened by bending or lying down
- Chest or abdominal pain, especially after meals
- Regurgitation of food or liquids
- Acid reflux into the esophagus
- Difficulty swallowing
- Shortness of breath
- Vomiting of blood (appearing like coffee grounds) or black stools, indicating GI bleeding
- Sensation of fullness and early satiety
Complications may include gastrointestinal bleeding caused by injury to the digestive tract at the hernia site, often resulting in fatigue from blood loss. In some cases, a paraesophageal hernia can become incarcerated—trapped in the thoracic cavity—leading to strangulation, compromised blood flow, and severe pain. These cases require immediate medical attention.
What Causes Hiatal Hernia?
While the exact cause is not always clear, several contributing factors have been identified:
- Trauma or previous surgical history
- Increased intra-abdominal pressure from heavy lifting, labor, or obesity (recommended article: What are the benefits of bariatric surgery VIDEO)
- Congenital widening of the diaphragmatic opening
- Risk factors such as aging and smoking
How Is Hiatal Hernia Diagnosed?
Diagnosis starts with a clinical evaluation of symptoms. To confirm and assess the condition, your doctor may recommend:
- Upper Digestive Endoscopy – A flexible tube with a camera is passed through the mouth to visualize the esophagus and stomach.
- Barium X-Ray (Barium Swallow) – You will drink a barium solution to outline the upper GI tract on X-rays.
What Are the Treatment Options for Hiatal Hernia?
Treatment depends on the severity of the symptoms and the risk of complications.
Drug Treatment
Medication aims to relieve symptoms such as acid reflux and pyrosis. Your doctor may prescribe:
- Antacids to neutralize gastric acid
- Medications to reduce acid production
- Proton pump inhibitors to block acid secretion and allow healing of the esophagus
Surgical Treatment
Surgery is recommended when symptoms are severe, medications are ineffective, or complications are likely. General surgery is a key specialty at VenArt Clinic.
How Is Surgery Performed?
Hiatal hernia surgery can be performed using one of three approaches, all under general anesthesia:
Laparoscopic Surgery
A minimally invasive method involving small abdominal incisions. A laparoscope (a thin tube with a camera and light) is inserted to repair the hernia and reinforce the diaphragmatic opening.
Benefits include:
- Lower infection risk
- Less postoperative pain
- Minimal scarring
- Faster recovery
- High patient satisfaction
Open Surgery
This method is more invasive, as it involves making a large incision to access and repair the hernia. The surgeon’s objective is to reposition the stomach correctly and wrap it around the lower section of the esophagus. This technique helps strengthen the walls of the digestive tract at that level, effectively preventing gastric acid from flowing back into the esophagus.
Endoluminal Fundoplication
This technique is the newest and least invasive of all surgical options. It requires no incisions; instead, the surgeon inserts an endoscope into the esophagus. Using this approach, small clips are placed at the junction where the esophagus meets the stomach. These clips help prevent acid and food from flowing back into the esophagus. It is important to note that this procedure is only suitable for certain patients.
Although prevention is often considered the best form of treatment, hiatal hernia is difficult to prevent entirely. Therefore, patients are advised to reduce risk factors by avoiding a sedentary lifestyle, not lying down immediately after meals, and waiting 2–3 hours before engaging in physical activity.
About Dr. Oleg Cebotari
Dr. Oleg Cebotari, a PhD candidate in Medical Sciences, completed his doctoral thesis on “Intestinal Resections in Non-Specific Inflammatory Bowel Diseases.” He has undergone extensive training in both Romania and Germany (Heidelberg). Known for his modern, patient-focused approach, Dr. Cebotari performs advanced laparoscopic and traditional procedures with exceptional results and is widely regarded in his field.
Hiatal Hernia Symptoms
Sliding hiatal hernias often present no symptoms, although patients may sometimes report GERD-related discomfort. Paraesophageal hernias also tend to be asymptomatic but can become incarcerated or strangulated, requiring urgent care. Both types may cause gastrointestinal bleeding—visible or hidden.
Diagnosis of Hiatal Hernia
Large hernias are often discovered incidentally during a chest X-ray. Small hernias are typically confirmed by barium swallow imaging.
Classification of Hiatal Hernias
- Sliding (Axial/Cardio-Esophageal) Hernia – The cardia and stomach slide into the thoracic cavity
- Rolling (Paraesophageal) Hernia – The gastric fundus herniates beside the esophagus without involving the cardia
- Mixed Hernia – A combination of both forms
Complications of Paraesophageal Hernia
Frequent complications include:
- Gastrointestinal Microbleeds and Anemia – Occur in up to 55% of cases
- Gastric Ulcers – On the herniated pouch, with risks of bleeding or perforation
- Gastric Volvulus – Stomach twists on its axis, leading to:
- Intense abdominal pain
- Unsuccessful vomiting efforts
- Inability to pass a gastric tube
On the barium transit, two superimposed pouches with distinct liquid levels are clearly visible. If the volvulus becomes strangulated, the patient may also show thoracic symptoms, such as difficulty breathing accompanied by abnormal sounds at the base of the lungs. The most severe and life-threatening complication is necrosis with perforation, which carries a mortality rate of approximately 50%.
Medical Consultant: Dr. Oleg Cebotari
