A hiatal hernia is a protrusion of part of the stomach across the opening of the diaphragm between the thoracic cavity and the abdominal cavity.  There is normally a hole here, called the hiatus, that allows the esophagus to pass through the diaphragm.  Normally the stomach remains below the diaphragm, however if the hiatus is large or loose, part of the stomach may protrude through this hole into the thoracic cavity. This may happen intermittently, called a sliding hiatus hernia, or permanently. Most children with hiatus hernia have no symptoms.  The hiatus hernia is typically small and of no clinical significance.  Nonetheless, a large hiatus hernia may lead to gastroesophageal reflux that is difficult to treat and or esophageal irritation.

What is a hiatus hernia?

A hiatus hernia (sometimes called a hiatal hernia) is a protrusion of part of the stomach through the hole that is normally found in the diaphragm.  If the protrusion of stomach tissue is intermittent, it is called a sliding hiatus hernia. With a large hiatus hernia, the protrusion of the stomach may be more persistent.

Who gets a hiatus hernia?

A hiatus hernia may occur at any age.  A mild, sliding hiatus hernia is very common in adults. Some estimate that up to 40% abnormal adults have a small hiatus hernia.  A hiatus hernia is even more common in the elderly population.

A large hiatus hernia that occurs at or before birth is called a diaphragmatic hernia.  A small diaphragmatic hernia may be small and asymptomatic or may cause severe compromise of lung development and breathing problems at birth. Most diaphragmatic hernias require surgical repair shortly after birth to allow enough space in the thoracic cavity for the lungs to develop normally.

 Hiatus hernias in children are uncommon.  When they do occur, they are typically small and cause few or no symptoms.

What causes a hiatus hernia?

A hiatus hernia is typically the result of a large, loose, or abnormal hole in the diaphragm. This hole, called the hiatus, normally allows the esophagus to pass through the diaphragm into the abdominal cavity where it can connect to the stomach. The hiatus is typically tight enough to prevent the stomach from sliding through, ut loose enough to allow food to pass through the esophagus to the stomach.

 The primary cause of an abnormal hiatus is unknown. A hiatal hernia in a newborn infant maybe associated with other anatomical abnormalities.

What are the symptoms of a hiatus hernia?

Most sliding hiatus hernias cause few or no symptoms. Typically only a small portion of the stomach protrudes through the diaphragm intermittently. A hiatus hernia may lead to gastroesophageal reflux that requires frequent medications or may be difficult to treat with medications.  Some people may have associated indigestion with a hiatus hernia. This may be worse after eating, moving, leaning forward, bearing down, or when lying.

How is a hiatus hernia diagnosed?

A routine chest x-ray may reveal some hiatal hernias.  Swallowing contrast material for an x-ray to makes it easier to visualize the anatomy of the esophagus.

What is the treatment for a hiatus hernia?

 Most hiatus hernias do not require treatment, especially small, sliding hiatus hernias. Routine gastroesophageal reflux precautions may be helpful. treatment for gastroesophageal reflux is sometimes necessary.

 A persistent hiatus hernia (sometimes called a paraesophageal hiatus hernia) may require surgical correction to prevent the tissue from getting stuck and losing its blood supply (called strangulation).

The following things may make the symptoms of a hiatus hernia worse:

• large meals
• overweight
• tobacco smoking
• lying down after meals
• tight fitting clothes
• acidic foods
• alcohol
• coffee and other caffeine-containing drinks
• spicy foods

 What is the prognosis for a hiatus hernia?

Most hiatus hernias cause no symptoms and require no specific treatment. Undertreated or unrecognized esophagus irritation (due to gastroesophageal reflux) that occurs over many years may cause permanent damage or increase the risk of esophageal cancer.

A hiatus hernia that is surgically corrected should cause no symptoms if the surgery was successful.

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