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Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Dennis Lee, MD

Dennis Lee, MD

Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.

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In this Article

• What is a hiatal hernia?
• What causes a hiatal hernia?
• Are there different types of hiatal hernias?
• What are the symptoms of hiatal hernia?
• How does a hiatal hernia cause GERD?
• How is a hiatal hernia diagnosed?
• How is a hiatal hernia treated?
• Hiatal Hernia At A Glance
• Patient Comments: Hiatal Hernia - Symptoms
• Patient Comments: Hiatal Hernia - Describe Your Experience
• Patient Comments: Hiatal Hernia - Effective Treatments
• Find a local Gastroenterologist in your town
• Hiatal Hernia Index

Hiatal hernias are diagnosed incidentally when an upper gastrointestinal x-ray or endoscopy is done during testing to determine the cause of upper gastrointestinal symptoms such as upper abdominal pain. On both the x-ray and endoscopy, the hiatal hernia appears as a separate "sac" lying between what is clearly the esophagus and what is clearly the stomach. This sac is delineated by the lower esophageal sphincter above and the diaphragm below. The hernia may only be visible during swallows, however.

Treatment of large para-esophageal hernias causing symptoms requires surgery. During surgery, the stomach is pulled down into the abdomen, the esophageal hiatus is made smaller, and the esophagus is attached firmly to the diaphragm. This procedure restores the normal anatomy.

Since sliding hiatal hernias rarely cause problems themselves but rather contribute to acid reflux, the treatment for patients with hiatal hernias is usually the same as for the associated GERD. If the GERD is severe, complicated, or unresponsive to reasonable doses of medications, surgery often is performed. At the time of surgery, the hiatal hernia is eliminated in a manner similar to the repair of para-esophageal hernias. However, in addition, part of the upper stomach is wrapped around the lower sphincter to augment the pressure at the sphincter and further prevent acid reflux.

• A hiatal hernia is an anatomical abnormality of the esophagus.
  
  
• Hiatal hernias contribute to gastro-esophageal reflux disease (GERD).
  
  
• The symptoms in individuals with hiatal hernias parallel the symptoms of the associated GERD.
  
  
• The treatment of most hiatal hernias is the same as for the associated GERD.