Hiatal Hernia: Symptoms, Causes, Diagnosis, and Treatment Options


A hiatal hernia is a medical condition where a portion of the stomach protrudes into the chest cavity through the diaphragm, which is the muscle that separates the abdomen from the chest. Hiatal hernia can lead to many discomforting symptoms and necessitates proper understanding and management. Typically categorised into two types, sliding and paraesophageal, hiatal hernias often lead to symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation. While the exact cause remains multifaceted, factors such as obesity, age, and persistent pressure on the abdomen may contribute to its development.

Treatment options vary based on the severity and specific type of hernia, ranging from lifestyle modifications and medication for mild cases to surgical intervention for more severe instances. A comprehensive understanding of hiatal hernias, encompassing their symptoms, underlying causes, diagnostic approaches, and available treatments, is crucial for individuals affected by this condition and healthcare professionals tasked with their care.

Symptoms of Hiatal Hernia

Hiatal hernias can vary in size and severity, meaning symptoms may range from mild to more pronounced. Some common symptoms include:

    • Heartburn: This is the most common symptom. It occurs when stomach acid backs up into the oesophagus, causing a burning sensation in the chest.
    • Regurgitation: Individuals with hiatal hernias may experience the sensation of acid or food returning to the throat or mouth.
    • Chest pain: This can often be mistaken for heart-related issues due to its location, but it’s typically a result of acid reflux.
    • Difficulty in swallowing: In severe cases, a hiatal hernia can narrow the opening in the diaphragm, making it harder to swallow food or liquids.
    • Acid Reflux: Regurgitation of stomach acid into the oesophagus, causing a sour taste in the mouth.
    • Difficulty Swallowing: Feeling like food is stuck in the throat or chest.
    • Belching or hiccups: These may be more frequent in individuals with a hiatal hernia.

Visual Representation of Hiatal Hernia

Causes of Hiatal Hernia

The exact cause of hiatal hernias is not always clear, but several factors may contribute to their development:

    • Age: Hiatal hernias are more common in individuals over 50.
    • Obesity: Excess weight can pressure the abdomen, potentially leading to a hiatal hernia.
    • Frequent Heavy Lifting: Heavy lifting activities can increase abdominal pressure and potentially lead to a hiatal hernia.
    • Genetics: There may be a genetic component, as some individuals may have a natural predisposition to developing hiatal hernias.
    • Pregnancy: The growing uterus can push the stomach upwards.

Diagnosis of hiatal hernia

Diagnosing a hiatal hernia typically involves a combination of medical history, physical examination, and imaging tests. These may include

    • Endoscopy: A thin, flexible tube with a camera (an endoscope) is passed down the throat to examine the oesophagus, stomach, and upper part of the small intestine.
    • Barium Swallow: This involves drinking a contrast material (barium) that makes the digestive tract visible on X-rays.
    • Esophageal Manometry: This test measures the pressure and coordination of the muscles in the oesophagus.
    • pH Monitoring: A small tube is placed in the oesophagus to measure acid levels over 24 hours.
    • Upper GI Series: Similar to a barium swallow, this involves drinking a contrast material while X-rays are taken.
    • CT Scan or MRI: These imaging tests can provide detailed images of the abdomen and diaphragm.

Barium X-ray of the upper gastrointestinal tract (UGI) showing hernia

Treatment Options for Hiatal Hernia

The treatment approach for hiatal hernia depends on the severity of the symptoms and the size of the hernia. Options may include

    • Lifestyle Changes: This can involve weight loss, avoiding large meals, and not lying down for at least 3 hours after a meal.
    • Medications: Over-the-counter or prescription medications can help reduce stomach acid and alleviate symptoms.
    • Surgery: Surgery may be recommended to repair the hernia in more severe cases, especially if there are complications like severe reflux or strangulation of the hernia.
    • Endoscopic Procedures: Some minimally invasive endoscopic procedures can be used to treat hiatal hernias, such as suturing or using special devices to reinforce the lower oesophagal sphincter.

When to Consult a Doctor

You can also get in touch with the expert Gastroenterology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.


Hiatal hernias can be uncomfortable and disruptive to daily life but they are manageable with proper medical care. It’s important to consult a healthcare professional for an accurate diagnosis and to discuss the best treatment options based on individual circumstances. Individuals with hiatal hernias can lead healthy, comfortable lives with the right approach.


Q. What are the three signs of hiatal hernia?
A. The three common signs of hiatal hernia include

  • Heartburn
  • Difficulty swallowing
  • Regurgitation of food

Q. What causes a hiatal hernia?
A. While the exact cause is not always clear, factors like age (especially over 50), obesity, pregnancy, heavy lifting, and genetics can contribute to developing a hiatal hernia.

Q. How is a hiatal hernia diagnosed?
A. Diagnosing a hiatal hernia involves a combination of medical history, physical examination, and imaging tests. These may include endoscopy, barium swallow, oesophagal manometry, and pH monitoring.

Q. What is the first-line treatment for hiatal hernia?
A. The first-line treatment for hiatal hernia often involves lifestyle modifications. This includes dietary changes, weight management, and avoiding lying down after meals. Medications to reduce stomach acid may also be prescribed. In severe cases, surgery may be considered as a treatment option. Always consult a healthcare professional for personalised advice.

Approved and Reviewed by:

Narayana Health

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