What is a hiatus hernia?

A hernia is where a part of the body protrudes through an abnormal opening in another part and gets into a space where it doesn't normally sit.

In a hiatus hernia, a part of the stomach pushes up through a hole in the diaphragm, the muscle that separates the chest from the abdomen. As a result, part of the stomach moves into the lower part of the chest.

A hiatus hernia can also be called a hiatal hernia.

Are there different types of hiatus hernias?

Hiatus hernias are classified into types, depending on which part of the stomach protrudes into the chest cavity:

• In sliding hiatus hernias, the upper part of the stomach (connected to the oesophagus, or 'food pipe') slides up into the chest through the diaphragm.
• In paraesophageal hernias, a lower part of the stomach (not connected to the oesophagus) moves into the chest.

More than 9 in every 10 people with hiatus hernias have the sliding type. Rarely, people can have both types of hiatus hernia at the same time. It's also possible for part of another abdominal organ, such as the small bowel, to protrude through the weakness in the diaphragm.

What are the symptoms of a hiatus hernia?

Many people with a hiatus hernia have no symptoms.

In other people, especially those with large hernias, a hiatus hernia can cause food and acid to move in the wrong direction from the stomach into the oesophagus.

This may cause symptoms of gastroesophageal reflux disease (also known as GORD or 'reflux') including:

• chest or abdominal pain
• shortness of breath
• heartburn
• an acidic taste in the back of the mouth
• bringing food or liquids back up into your mouth (regurgitation)
• difficulty swallowing
• vomiting

Some people with a hiatus hernia burp or feel bloated often.

What causes a hiatus hernia?

A hiatus hernia is caused by a weakness in the opening in the diaphragm, allowing part of the stomach to slide through the diaphragm.

It's not always clear what causes this, but factors that increase your risk of developing a hiatus hernia include:

• being over 50 years of age
• being overweight
• excessive straining — for example with frequent coughing, vomiting, lifting or straining when passing a bowel movement
• being born with a large gap in your diaphragm

When should I see my doctor?

You should see your doctor if:

• your symptoms continue for at least 3 weeks; or
• your symptoms are getting worse; and/or
• over-the-counter medicines aren't controlling your symptoms

See a doctor right away if you have a hiatus hernia and you experience problems with swallowing, breathing or if:

• you have pain that is getting worse
• you are vomiting frequently
• there is blood in your vomit or poo

How will I be diagnosed with hiatus hernia?

You may be diagnosed with a hiatus hernia if you have tests to find the cause of symptoms such as reflux, chest pain or upper abdominal pain.

These tests may include:

• x-rays of your chest or abdomen
• endoscopy — where a camera is used to look at the inside of your oesophagus and stomach
• oesophageal manometry — a test used to look at the muscles of your oesophagus

What treatment will I need for a hiatus hernia?

If you have symptoms of GORD caused by a hiatus hernia, you can reduce or relieve your symptoms by:

• avoiding foods that worsen your symptoms of reflux - these may include fatty foods, chocolate, mint, alcohol and caffeine
• eating smaller meals
• not lying down straight after eating
• losing any excess weight
• quitting smoking

You can buy antacids over the counter to neutralise stomach acid and relieve your symptoms. There are also other medicines available, and you can talk to your pharmacist or doctor to find out more. A small number of people need surgery.

Can I prevent getting a hiatus hernia?

You are less likely to develop a hiatus hernia if you are at a healthy weight and if you avoid becoming constipated.

What are the complications of a hiatus hernia?

A hiatus hernia can cause GORD (reflux), which is when stomach acid flows back into your oesophagus and mouth. Long-term, this can damage your oesophagus. See your doctor if you notice these complications of hiatus hernia.