Hiatal Hernia

The gastroenterology experts at Tampa General Hospital’s Digestive Diseases Institute offer treatment for hiatal hernias, a condition that occurs when part of the stomach bulges through the diaphragm and into the chest. The diaphragm is a large muscle that separates the chest cavity from the abdominal cavity, and it contains a small opening known as the esophageal hiatus. Normally, the esophagus (the tube that connects the mouth to the stomach) passes through this opening before it reaches the stomach. But when someone has a hiatal hernia, the upper portion of their stomach pushes up through the opening and into their chest cavity. Hiatal hernias are very common, especially among the older population.

Types of Hiatal Hernias

The medical community classifies hiatal hernias into the following four types:

• Type 1: With this type of hiatal hernia, the portion of the esophagus that connects to the stomach (the gastroesophageal junction) slides up and down through the esophageal hiatus. The vast majority of hiatal hernias fall into this type.
• Type 2: Sometimes referred to as rolling hiatal hernias, these develop when the upper portion of the stomach pushes through the esophageal hiatus alongside the esophagus and forms a bulge next to it.
• Type 3: These hiatal hernias occur when the gastroesophageal junction slides up through the esophageal hiatus and another section of the stomach also bulges through.
• Type 4: With this type of hiatal hernia, the stomach and another abdominal organ (e.g., the pancreas or spleen) both bulge through the esophageal hiatus. Type 4 hiatal hernias are rare.

Type 1 hiatal hernias are known as sliding hiatal hernias, while Types 2 through 4 are considered to be paraesophageal hiatal hernias.

Causes and Risk Factors of Hiatal Hernias

When the diaphragm weakens, it makes it easier for the stomach to bulge through the esophageal hiatus. The diaphragm weakness that can lead to a hiatal hernia may result from:

• The natural aging process
• Chronic abdominal pressure (for example, the pressure exerted when coughing, sneezing, lifting a heavy object, exercising, vomiting, or straining to have a bowel movement)
• A congenital defect that causes the esophageal hiatus to be larger than normal
• An injury from a sudden trauma or a previous surgery

Being over age 50, being obese, and being pregnant can all increase your risk of developing a hiatal hernia.

Signs and Symptoms of Hiatal Hernias

In many cases, small hiatal hernias don’t produce any noticeable symptoms. In fact, many people aren’t even aware that they have a hernia until their doctor discovers it while treating another condition. However, larger hiatal hernias can cause food and stomach acid to back up into the esophagus, producing symptoms such as:

• Heartburn
• Chest or abdominal pain
• Shortness of breath
• Feeling full soon after eating
• Burping
• Regurgitating food or liquid
• Sore throat
• Hoarseness
• Difficulty swallowing
• Nausea
• Vomiting blood
• Passing black stools

In some cases, the bulging produced by paraesophageal hernias can be seen from outside the body. If you’re experiencing symptoms like these, it’s important to promptly seek treatment, as chronic acid reflux can damage the esophagus. Plus, once hiatal hernia symptoms occur, they tend to worsen over time. In some cases, hiatal hernias can lead to complications such as gastritis, gastrointestinal obstructions, and ischemia.

Diagnosing Hiatal Hernias

If a patient’s medical history and symptoms (if any) suggest the presence of a hiatal hernia, a doctor may use one or more of the following tests to confirm the diagnosis:

• Esophageal manometry
• Esophageal pH test
• Esophagram
• Upper endoscopy
• X-ray

Hiatal Hernia Treatment

Hiatal hernias generally don’t require treatment unless they’re producing symptoms. When symptoms do occur, treatment may involve:

• Implementing lifestyle changes such as eating smaller meals, eating earlier in the evening, avoiding foods that trigger heartburn, waiting to lie down after eating, losing excess weight, quitting smoking, sleeping on your left side, and elevating the head of your bed
• Taking medication to reduce or block stomach acid production, neutralize stomach acid, or heal the esophagus
• Undergoing hiatal hernia surgery to return the stomach to the abdomen, reduce the size of the esophageal hiatus, or reshape the lower esophageal muscles

After learning about your condition and the symptoms you’re experiencing, a skilled medical provider will be able to recommend the treatment approach that’s most appropriate for your needs. For example, hiatal hernias generally only need surgery when they’ve led to complications or when conservative treatment methods have failed to provide sufficient relief. If you’re a candidate for surgery, your hiatal hernia surgeon will walk you through what the procedure involves and what you can expect to happen both before and after.

TGH’s Approach to Treating Hiatal Hernias

If you think you might have a hiatal hernia, it’s important to promptly seek treatment, so contact Tampa General Hospital at (800) 822-3627 and request a consultation at our Tampa, FL, Digestive Diseases Institute. U.S. News & World Report named us as one of the best hospitals for Gastroenterology and GI Surgery for 2023-24 and you can feel confident knowing that we take a multidisciplinary approach to patient care—with highly skilled surgeons, gastroenterologists, radiologists, medical oncologists, and pharmacotherapists working together at a single location. In addition, our Gastroesophageal Reflux Disease (GERD) and Esophageal Surgery Center offers tertiary and quaternary esophageal care—meaning we see and treat some of the most complex cases in the region.