Hiatal Hernia

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Bhupinder Anand, MD
woman with abdominal pain
Is exercise safe with a hiatal hernia?

Hiatal Hernia

What are Symptoms of Hiatal Hernia?

A hiatal hernia is an abnormality where a part of the stomach slides up into the chest cavity, past the diaphragm. It is usually caused by a weakness of the diaphragm muscle. You may not have any symptoms with your hiatal hernia. However, sometimes, hiatal hernias may cause acid reflux or gastroesophageal reflux (GERD), which is when stomach acid backs up into the esophagus. This may lead to symptoms such as:

  • a burning sensation in your chest (heartburn),
  • acid taste in your mouth,
  • chest pain,
  • stomach pain,
  • sweating,
  • difficulty swallowing,
  • raspy voice,
  • sore throat, or
  • cough.

Hiatal hernia definition

The esophagus connects the mouth and throat to the stomach. It passes through the chest cavity and enters the abdominal cavity through a hole in the diaphragm called the esophageal hiatus. The term hiatal hernia describes a condition where a part of the stomach that normally is located in the abdominal cavity pushes or protrudes through the esophageal hiatus to rest within the chest cavity.

What causes a hiatal hernia?

Normally, the space where the esophagus passes through the diaphragm is sealed by the phrenoesophageal membrane, a thin membrane of tissue connecting the esophagus with the diaphragm where the esophagus passes through the diaphragm, so that the chest cavity and abdominal cavity are separated from each other. Because the esophagus shortens and lengthens with each swallow, essentially squeezing food into the stomach, this membrane needs to be elastic to allow the esophagus to move up and down. Normal physiology allows the gastroesophageal (GE) junction, where the esophagus and stomach meet, to move back and forth from just below to just above the diaphragm. However, at rest the GE junction should be located below the diaphragm and in the abdominal cavity. It is important to remember that these distances are very short.

Over time, the phrenoesophageal membrane may weaken, and a part of the stomach may herniate through the membrane and remain above the diaphragm permanently.

  • Decreased abdominal muscle tone and increased pressure within the abdominal cavity may lead to the development of a hiatal hernia. Thus, peopole who are obese and women who are pregnant are at an increased risk for developing a hiatal hernia.
  • People who have repetitive vomiting or those who have constipation and strain to have a bowel movement, increase the intra-abdominal pressure when they strain, and this may weaken the phrenoesophageal membrane.
  • The membrane also may weaken and lose its elasticity as a part of aging.
  • Ascites, an abnormal collection of fluid in the abdominal cavity often seen in people with liver failure, also is associated with the development of a hiatal hernia.

Picture of Hiatal Hernia
Picture of Hiatal Hernia
Medically Reviewed by a Doctor on 2/10/2015

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