One of the most common findings that we encounter, and that patients ask us about, is a hiatal hernia. Here’s what you need to know.
What is a hiatal hernia?
A hiatal hernia occurs when the stomach pushes through (herniates) the small opening (hiatus) in the diaphragm, which holds it below the chest cavity. Normally, the esophagus joins the stomach at the level of the diaphragm. This is a tight connection, which helps to prevent acid reflux, and keeps the stomach in the abdominal cavity. Over time, the opening in the diaphragm can weaken and enlarge, allowing the stomach to slide upward into the chest. This is known as a sliding-type hernia, which is the most common form of hiatal hernia.
How common are hiatal hernias?
Hiatal hernias are very common. We don’t know the exact prevalence, but estimates range anywhere between 10% and 80% of adults, depending on the means of diagnosis and the population studied. In reality, a majority of adults, particularly adults over the age of 50, probably has at least a small hiatal hernia.
What are the symptoms of a hiatal hernia?
Usually none. Occasionally, a hiatal hernia can lead to acid reflux and its associated symptoms (heartburn, acid taste in the mouth, cough). People with very large hiatal hernias may experience regurgitation of liquid or acid, particularly when lying flat or bending forward.
How is it diagnosed?
A hiatal hernia can be seen at the time of an upper endoscopy or during an xray test (such as a barium swallow or CT scan). This is often found incidentally, meaning during an evaluation for other symptoms.
How is it treated?
Because most hiatal hernias are asymptomatic, specific treatment is usually not needed. For individuals with acid reflux, the primary treatment is acid-reducing medications, particularly the proton pump inhibitors (such as Nexium and Prilosec). Weight loss and lifestyle change are also important, as abdominal obesity can significantly increase symptoms.
Does a hiatal hernia need to be surgically repaired?
Very rarely. While a surgeon can surgically repair a hiatal hernia (typically with a procedure known as a fundoplication), very few people actually need this surgery. That is because reflux symptoms are effectively managed with medications and lifestyle change. In a rare circumstance, someone may have continued reflux symptoms despite maximal medical therapy. In that case, surgical repair of the hernia may be considered, but it is important to first prove that symptoms are actually related to acid reflux (usually with pH testing).
Can you fix a hernia with special exercises?
Absolutely not. This is an internet myth, promoted by bogus websites with financial motivations. You can’t massage, jump, shake, or otherwise correct a hiatal hernia through exercise. More importantly, hiatal hernias don’t usually cause symptoms, so there’s really no need to fix them.
Bottom line: Hiatal hernias are common, and usually don’t cause symptoms. In some cases, a hiatal hernia may lead to acid reflux symptoms, but these are typically responsive to acid suppression, lifestyle change, and weight loss.
-Christopher McGowan, MD, MSCR