Hiatus hernia

Your oesophagus connects to your stomach by passing through a gap in your diaphragm called the hiatus. A hiatus hernia develops when part of your intestines, usually the stomach, squeezes through this hole.

A hiatus hernia can affect the diaphragm’s ability to stop stomach acid escaping into your oesophagus (gullet), triggering acid reflux. This can cause heartburn and, in some cases, gastro-oesophageal reflux disease (GORD).

Having a hiatus hernia is very common and can affect anyone at any age, although it’s more likely if you’re older. It’s estimated that one in three people over the age of 50 has a hiatus hernia. You’re also more likely to develop a hiatus hernia if you’re overweight or pregnant.

In many cases, a hiatus hernia requires no treatment – simple lifestyle changes can relieve any symptoms. However, sometimes hiatus hernia medication or surgery may be necessary.

A hiatus hernia is often symptomless and won’t give you any problems.

If symptoms do occur, the most common is heartburn. Other hiatus hernia symptoms include:

• A sour taste at the back of your mouth
• Regurgitation of food
• Bad breath
• Burping, bloating, nausea and/or vomiting
• Difficulty swallowing

Occasionally, heartburn caused by a hiatus hernia can trigger severe chest pain. It can be difficult to distinguish chest pain associated with a hiatus hernia from a heart attack, so if you do have chest pain, seek medical attention immediately.

If your hiatus hernia symptoms continue for over three weeks and over-the-counter medication isn’t helping, see your GP.

Your GP will discuss your symptoms and your general health. Your GP may refer you to a gastroenterologist (a consultant specialising in the digestive system) for further assessment and treatment.

The tests you may need include:

• Gastroscopy (endoscopy) – a tiny camera that films inside your stomach and gullet
• Barium swallow test – drinking a chalky liquid before having a series of X-rays to identify any problems in your digestive system

It’s unclear what the causes of a hiatus hernia are, but it may be:

• Weakening of your diaphragm as you age, allowing the stomach to squeeze through
• Repeated heavy lifting or coughing
• Obesity
• Family history of hiatus hernia
• Injury or an operation near your stomach or oesophagus
• Scoliosis or kyphosis – a curved spine

There are several ways you can help relieve hiatus hernia symptoms. These include:

• Identify the foods that trigger heartburn related to hiatus hernia – foods to avoid often include fatty, spicy and fried foods
• Have smaller, more frequent meals and chew your food properly
• Live a healthier life – stop smoking, don’t drink too much alcohol, lose any excess weight and take time to relax
• Raise the head of your bed so you’re slightly tilted when sleeping
• Avoid bending over, lying down or lifting heavy objects immediately after eating or drinking

Over-the-counter medications such as antacids may successfully relieve your hiatus hernia symptoms, especially heartburn. Alternatively, your GP or consultant may prescribe a short course of medication to suppress or reduce the production of stomach acid.

If lifestyle changes and medication are unsuccessful and your symptoms are very severe, your GP or consultant may suggest surgery. A hiatus hernia operation is usually done as keyhole (laparoscopic) surgery and has a good success rate. However, further surgery may be required if the hiatus hernia returns.