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Hiatus hernia

A hiatus hernia is when part of the stomach moves up into your chest through a hole in your diaphragm called the hiatus. It is thought that up to 50% of the population has a hiatus hernia.

What is a hiatus hernia?

There are two types of hiatus hernia:

  • Sliding – this is the most common type. In a sliding hiatus hernia, part of your stomach moves up into your chest
  • Paraoesophageal – this can also be known as a rolling hiatus hernia, and it is potentially a more serious form of hiatus hernia. With this type, a part of your stomach moves into your chest, but sits beside your oesophagus. It’s possible that your stomach can become restricted and begin to lose its blood supply

What are the symptoms of a hiatus hernia?

It’s possible that you may have a hiatus hernia without presenting any symptoms at all. However, if you do have symptoms they may include.

  • Heartburn
  • Acid reflux
  • Issues with swallowing
  • Food or liquids are regurgitated into your mouth
  • Bad smelling breath (halitosis)
  • Bloating
  • Burping or belching
  • Pain in the chest or abdomen
  • Breathlessness
  • Nausea
  • Blood in your stool
  • Vomiting blood
  • Hoarse voice / persistently needing to clear your throat
  • Dental decay

What causes a hiatus hernia?

It’s not always understood what exactly causes a hiatus hernia, but it is thought that it can be related to:

  • Older age
  • Repeated strain on the abdominal muscles (e.g. frequent coughing, straining due to constipation, lifting heavy items)
  • Pregnancy
  • Obesity
  • Surgery or trauma to the abdominal area
  • Your hiatus is larger than usual
  • Many have this since birth but become symptomatic later in life due to lifestyle changes or because the valves between the stomach and oesophagus weaken or stop working

How are hiatus hernias diagnosed?

If you have been experiencing any of the symptoms listed above, you should speak to your consultant.

At your appointment, your consultant will inquire about your symptoms, medical history and may conduct a physical examination. If more investigation is needed, they might recommend that you undergo:

  • X-rays – of the chest and upper digestive tract
  • An endoscopy – a thin tube affixed with a camera is put down your throat, which allows your consultant to see your oesophagus and stomach
  • Barium swallow – your consultant will ask that you drink a liquid that will highlight your stomach and oesophagus on an x-ray
  • Oesophageal manometry – a test to assess the pressure on your oesophagus each time you swallow. This is done by placing a thin tube down your throat. This is a test to check your oesophageal function – a tube is inserted into your nose, down towards your oesophagus to see how well it is working
  • pH testing / BRAVO studies – these tests give your consultant an objective value of how much acid is effecting your oesophagus
  • Breath tests – to see if there are any bacterial causes to your symptoms, especially if you have associated bloating or belching

How is a hiatus hernia treated?

The treatment for a hiatus hernia depends on its severity, type and whether it is causing problems in your day-to-day life. Treatments for a hiatus hernia include:

  • Lifestyle changes (e.g. quitting smoking, losing weight)
  • Diet changes (e.g. limiting foods that you find give you heartburn)
  • Medication to help alleviate your symptoms (e.g. antacids)
  • Surgery – this is most often done as a laparoscopic surgery to correct the hiatus hernia

You and your consultant can further discuss which treatment option would be best for you.

If you’re unsure what treatment you should go for, or the above treatments don’t work for you, our team of expert specialists are here to help.

This content has been checked and approved by

Professor Sanjay Purkayastha  ›

Mr Sanjay Purkayastha is a Consultant General Surgeon at King Edward VII’s Hospital with a specialist interest in Bariatric & Upper GI Surgery.

Hernia Health Check Package

If you’re experiencing symptoms of a hernia such as a visible lump or bulge coming out of your stomach, inner thigh or groin area, you may be seeking a diagnosis so we’ve created a hernia health check package just for you.

Find your specialist in hiatus hernias at King Edward VII's Hospital

If you suspect you have a hiatus hernia and you’re seeking an expert opinion, you can find the UK’s leading specialists here at King Edward VII’s Hospital. Our consultants are hand-picked for you, making it easy to access the best possible care.

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