Quick answer: A hiatal hernia (also known as a diaphragmatic hernia) is a condition in which part of the stomach protrudes through the diaphragm into the chest cavity. Symptoms may include heartburn, chest pain and acid reflux. In the majority of cases, it can be treated with medication and lifestyle changes.
Have you ever heard of someone having a „reflux hernia”? It was probably a hiatal hernia – a fairly common condition that can remain asymptomatic for a long time, but can cause serious discomfort over time. Many people struggle with heartburn, acid reflux and chest pain for years without realising that a diaphragmatic hernia is the underlying cause.
This article explains exactly what a hiatal hernia is, the different types and symptoms, how it is diagnosed, and what treatment options are available. Our aim is to summarise everything worth knowing about this condition in a clear and accessible way – without using medical jargon.
What exactly is a hiatal hernia?
The abdominal cavity and the thoracic cavity are separated by a muscular sheet known as the diaphragm. The oesophagus passes through this diaphragm before joining the stomach – at this point of passage there is a small opening known as the hiatus.
In the case of a hiatal hernia, part of the stomach – or, less commonly, another abdominal organ – slides up through this opening into the chest cavity. As a result, stomach acid can more easily flow back into the oesophagus, causing the characteristic symptoms of reflux.
The exact prevalence of the condition is difficult to measure, as a hiatal hernia can remain asymptomatic for many years. However, it is considered a relatively common condition amongst people over the age of 50.
Types of gastric hiatal hernia according to the SAGES 2013 classification
We distinguish between four main types of diaphragmatic hernia:
- Type I (sliding hernia): This is the most common form, accounting for more than 95% of all cases. In this condition, the gastro-oesophageal junction (cardia) and part of the stomach slide up above the diaphragm and then slide back down again. Symptoms may worsen when lying down or bending forward.
- Type II (purely para-oesophageal hernia): The position of the cardia remains normal, but part of the stomach – the fundus – pushes up above the diaphragm alongside the oesophagus. This form is less common, but carries a higher risk of complications.
- Type III (mixed type): Both the cardia and the fundus are positioned above the diaphragm. More than 90% of para-oesophageal hernias fall into this category.
- Type IV: The rarest and most severe form, in which, in addition to the stomach, other abdominal organs (e.g. the omentum or the large intestine) are also present in the hernial sac.
What symptoms does a hiatal hernia cause?
The most common symptom of a hiatal hernia is what is known as acid reflux, i.e. the backflow of stomach acid into the oesophagus. This causes a burning sensation and heartburn – particularly after eating, when lying down or when bending forward. Many patients are unaware that a hernia is actually the underlying cause.
The most common symptoms are:
- Heartburn: A burning, uncomfortable sensation in the chest or the upper part of the stomach.
- Backflow (regurgitation): A sour taste in the mouth, particularly after meals.
- Chest pain: A sensation of pressure behind the breastbone, which is easily mistaken for heart-related symptoms.
- Difficulty swallowing (dysphagia): It feels as if the food is getting stuck in your throat or chest.
- Nausea: Mainly after meals.
- Chronic cough, hoarseness: The acid that flows back can irritate the airways and the vocal cords.
It is important to note that in many cases these symptoms do not occur at all. A hernia may develop without causing any symptoms; in such cases, it is discovered by chance during other investigations.
When should you see a doctor if you suspect you have a hiatal hernia?
You should seek medical help if:
- heartburn occurs on a weekly basis,
- the symptoms cannot be relieved by over-the-counter medicines,
- difficulty swallowing, persistent nausea or weight loss may also be experienced,
- chest pain occurs (which must first be distinguished from a heart problem),
- the symptoms intensify or worsen.
Untreated, long-term reflux can also lead to complications – such as damage to the oesophageal tissue – which is why early diagnosis is important.
Why do hiatal hernias develop? – Causes and risk factors
The elasticity of the diaphragm decreases with age; consequently, hiatal hernias are most common in people over the age of 50. Conditions that increase intra-abdominal pressure may also contribute to the widening of the diaphragmatic opening:
- Obesity: Abdominal fat tissue exerts constant pressure on the diaphragm.
- Pregnancy: Intra-abdominal pressure increases particularly during the later stages of pregnancy.
- Chronic constipation: Repeated straining puts a strain on the diaphragm.
- A persistent, severe cough: For example, in smokers or people with asthma.
- Smoking: An independent risk factor that damages the entire digestive system.
- Sudden, severe vomiting: It may place mechanical strain on the opening of the diaphragm.
Congenital diaphragmatic hernias are rare, but they can occur, particularly in newborns – this condition requires immediate medical attention.
How is a hiatal hernia diagnosed?
A diagnosis of a hiatal hernia is usually made by means of an endoscopic examination of the upper gastrointestinal tract, that is to say, by gastroscopy takes place. This examination enables the doctor to directly examine the mucous membranes of the oesophagus and stomach, identify the location and type of the hernia, and assess any possible complications (e.g. inflammation, ulcers, Barrett’s oesophagus).
A gastroscopy may be indicated:
- in cases of persistent heartburn or reflux symptoms,
- in the presence of warning signs (weight loss, anaemia, difficulty swallowing),
- in cases where symptoms do not respond to medication,
- in order to rule out complications.
At the Endomedix Private Gastroenterology Clinic, the GASTROSCOPY UNDER ANAESTHESIA During the procedure, the patient sleeps deeply – for technical reasons, at Endomedix we use only general anaesthesia, not sedation. This means that the patient feels and perceives nothing during the examination; the procedure takes place in a stress-free and pain-free environment. The method is particularly recommended for those who feel anxious about the examination.
In addition to an upper gastrointestinal endoscopy, other diagnostic procedures may also be considered:
- Chest X-ray: In the case of a more severe hernia, the part of the stomach protruding into the chest cavity may become visible in the image.
- Contrast-enhanced oesophagram (barium X-ray): The exact location and size of the hernia can be determined using the contrast medium that has been injected.
How can a hiatal hernia be treated?
The extent of treatment depends on the type of hernia and the severity of the symptoms. In the majority of cases, significant improvement can be achieved without medical intervention.
Lifestyle changes – the first step
In the case of mild or moderate symptoms, the following lifestyle changes can be of great help:
- Raising the head of the bed: Raising the head of the bed by a few centimetres reduces the likelihood of reflux whilst sleeping.
- Smaller but more frequent meals: Large, fatty meals make reflux worse.
- Weight loss: Reducing abdominal fat relieves the pressure on the diaphragm.
- Giving up smoking: Smoking weakens the pyloric sphincter and increases acid production.
- Scheduled meals: Finish your last meal at least 2–3 hours before going to bed.
- Avoiding tight-fitting clothes: Clothes that put pressure on the abdomen may make the symptoms worse.
Medication
If lifestyle changes do not bring about sufficient improvement, your doctor may prescribe medication to reduce acid production. Two main groups of medication are used:
- Proton pump inhibitors (PPIs): They effectively reduce the production of stomach acid and, in most cases, bring reflux symptoms under good control.
- H2 receptor blockers: They also have an acid-reducing effect and are generally sufficient in milder cases.
These medicines should only be taken over the long term on medical advice, and regular monitoring is recommended whilst taking them.
Surgical treatment – when is it necessary?
In the majority of cases, surgery is not required. Surgical intervention may be considered if:
- despite medication, the symptoms remain severe and persistent,
- there is regurgitation, severe difficulty swallowing or permanent damage to the oesophageal tissue,
- In the case of a para-oesophageal hernia, there is a risk of strangulation.
Hernia surgery is now usually performed using a laparoscopic technique – It is carried out using a minimally invasive technique. This means that, instead of a large abdominal incision, the procedure is performed through a few small incisions, resulting in a quicker recovery, fewer complications and smaller scars.
The role of Endomedix in the diagnosis of hiatal hernias
Accurate, professional diagnosis is the cornerstone of the recognition and treatment of hiatal hernias. The Endomedix Private Gastroenterology Clinic offers patients a high standard of professional expertise and state-of-the-art equipment.
If you are suffering from persistent heartburn, acid reflux, chest pressure or other digestive problems, do not delay your consultation. Our specialists will not only carry out the examination, but will also explain the results clearly and draw up a personalised treatment plan.
Book an appointment at Endomedix – and take the first step towards resolving your complaints: https://endomedix.hu/vizsgalatok/gasztroenterologiai-szakorvosi-konzultacio/
What should you bear in mind about a hiatal hernia?
A hiatal hernia is a relatively common but often misdiagnosed condition. Its symptoms – particularly heartburn and acid reflux – may initially seem like minor complaints, but if left untreated, they can cause permanent damage to the oesophagus.
The good news is that, with the right lifestyle changes and medication, symptoms can be well managed in the majority of cases. Early detection is key: if symptoms recur or worsen, it is advisable to undergo a gastroenterological examination.
Frequently asked questions about hiatal hernias
What is the difference between a hiatal hernia and acid reflux?
A hiatal hernia is an anatomical abnormality in which part of the stomach slips above the diaphragm. Reflux – that is, the backflow of acid into the oesophagus – can be one of its consequences, but reflux can also occur without a hiatal hernia. The two conditions are therefore related, but they are not the same.
Is a hiatal hernia dangerous?
In most cases, no. A small hernia that causes few symptoms does not require treatment. However, untreated, persistent reflux can lead to serious complications, such as Barrett’s oesophagus or even cancer. This is why regular check-ups are important.
Does a gastroscopy hurt?
At Endomedix, during a gastroscopy under general anaesthesia, the patient is completely asleep, feels nothing and experiences no discomfort. For medical reasons, we use general anaesthesia exclusively, rather than sedation. The patient wakes up within a few minutes of the procedure and can usually go home after a few hours.
Can a hernia at the corner of the mouth heal on its own?
The anatomical abnormality – the hernia itself – does not resolve on its own. However, the symptoms can be managed effectively through appropriate lifestyle changes and medication. In more severe cases, laparoscopic surgery can provide a permanent solution to the hernia.
What foods should you avoid if you have a hernia?
Fatty, spicy foods, citrus fruits, tomatoes, chocolate, caffeine and alcohol can all exacerbate reflux symptoms. A gastroenterologist is best placed to help you review your eating habits on an individual basis.
How common is a hiatal hernia in people over the age of 50?
Amongst people over the age of 50, the elasticity of the diaphragm decreases, so the incidence of this condition rises significantly in this age group. As it can remain symptom-free for a long time, it is difficult to compile accurate statistics, but regular screening is particularly recommended at this age.
