A hiatal hernia is an abnormal protrusion of the stomach up through the diaphragm and into the chest cavity.
A hiatal or diaphragmatic hernia is different from abdominal hernias in that it is not visible on the outside of the body. With a hiatal hernia, the stomach bulges upward through the esophageal hiatus (the hole through which the esophagus passes) of the diaphragm. This type of hernia occurs more often in women than in men, and it is treated differently from other types of hernias.
Causes & symptoms
A hiatal hernia may be caused by obesity, pregnancy, aging , or previous surgery. About 50% of all people with hiatal hernias do not have any symptoms. For those who do have symptoms, they include heartburn , usually 30–60 minutes after a meal, or mid-chest pain due to gastric acid from the stomach being pushed up into the esophagus. The pain and heartburn are usually worse when lying down. Frequent belching and feelings of abdominal fullness may also occur.
The diagnosis for a hiatal hernia is based on a person's reported symptoms. The doctor may then order tests to confirm the diagnosis. If a barium swallow is ordered, the person drinks a chalky white barium solution, which will help any protrusion through the diaphragm to show up on the x ray that follows. Currently, a diagnosis of hiatal hernia is more frequently made by endoscopy. This procedure is done by a gastroenterologist (a specialist in
digestive diseases). During an endoscopy the person is given an intravenous sedative and a narrow tube is inserted through the mouth and esophagus, into the stomach where the doctor can visualize the hernia. The procedure takes about 30 minutes and may cause some discomfort, but usually no pain. It is done on an outpatient basis.
Dietary and lifestyle adjustments to control a hiatal hernia include:
- Avoiding reclining after meals.
- Avoiding spicy foods, acidic foods, alcohol, and tobacco.
- Eating small frequent bland meals to keep pressure on the esophageal sphincter.
- Eating a high-fiber diet.
- Raising the head of the bed several inches with blocks to help both the quality and quantity of sleep.
Visceral manipulation done by a trained therapist can help return the stomach to its proper positioning. Deglycyrrhizinated licorice (DGL), helps balance stomach acid by improving the protective substances that line the stomach and intestines and by improving blood supply to these tissues. DGL does not interrupt the normal function of stomach acid.
There are several types of medications that help to manage the symptoms of a hiatal hernia. Antacids are used to neutralize gastric acid and decrease heartburn. Drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatal hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the esophagus and causes the stomach to empty more quickly.
Hiatal hernias are treated successfully with medication and diet modifications 85% of the time. The prognosis remains excellent even if surgery is required in adults who are otherwise in good health.
Some hernias can be prevented by maintaining a reasonable weight, avoiding heavy lifting and constipation , and following a moderate exercise program to maintain good abdominal muscle tone.
Bare, Brenda G. and Suzanne C. Smeltzer. Brunner and Suddarth's Textbook of Medical-Surgical Nursing. 8th edition. Philadelphia: Lippincott-Raven Publishers, 1996.
Polaske, Arlene L. and Suzanne E. Tatro. Luckmann's Core Principles and Practice of Medical Surgical Nursing. Philadelphia: W.B. Saunders Company, 1996.
Kingsley, A.N., I.L. Lichtenstein, and W.K. Sieber. "Common Hernias In Primary Care." Patient Care. (April 1990): 98-119.
"Hiatal Hernia." Gale Encyclopedia of Alternative Medicine. . Encyclopedia.com. (May 24, 2018). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/hiatal-hernia
"Hiatal Hernia." Gale Encyclopedia of Alternative Medicine. . Retrieved May 24, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/hiatal-hernia
Encyclopedia.com gives you the ability to cite reference entries and articles according to common styles from the Modern Language Association (MLA), The Chicago Manual of Style, and the American Psychological Association (APA).
Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.
Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:
Modern Language Association
The Chicago Manual of Style
American Psychological Association
- Most online reference entries and articles do not have page numbers. Therefore, that information is unavailable for most Encyclopedia.com content. However, the date of retrieval is often important. Refer to each style’s convention regarding the best way to format page numbers and retrieval dates.
- In addition to the MLA, Chicago, and APA styles, your school, university, publication, or institution may have its own requirements for citations. Therefore, be sure to refer to those guidelines when editing your bibliography or works cited list.
"hiatus hernia." A Dictionary of Food and Nutrition. . Encyclopedia.com. (May 24, 2018). http://www.encyclopedia.com/education/dictionaries-thesauruses-pictures-and-press-releases/hiatus-hernia
"hiatus hernia." A Dictionary of Food and Nutrition. . Retrieved May 24, 2018 from Encyclopedia.com: http://www.encyclopedia.com/education/dictionaries-thesauruses-pictures-and-press-releases/hiatus-hernia