Hiatal Hernia: Symptoms, Causes, Treatment Options and When Surgery May Be Needed?

Heartburn, acid reflux and chest or upper abdominal discomfort are common digestive complaints. But when these symptoms occur frequently, the underlying cause may sometimes be more than simple acidity.

One possible cause is a hiatal hernia, a condition in which part of the stomach moves upward through an opening in the diaphragm into the chest.

Some hiatal hernias cause no symptoms and may be discovered during an investigation for another condition. Others can contribute to persistent reflux, swallowing difficulties and other digestive problems.

The diaphragm is a large muscle that separates the chest from the abdomen. The food pipe, or oesophagus, passes through an opening in the diaphragm before connecting to the stomach.

A hiatal hernia occurs when part of the stomach pushes through this opening and moves into the chest.

There are different types of hiatal hernia, with sliding hiatal hernia being the most common.

The exact cause may not always be clear.

Several factors can contribute to the development of a hiatal hernia, including:

• Age-related changes
• Weakening of tissues around the diaphragm
• Increased pressure inside the abdomen
• Obesity
• Chronic coughing
• Persistent constipation and straining
• Heavy lifting
• Pregnancy
• Previous injury or surgery in some cases

Hiatal hernia becomes more common with increasing age, although it can occur in younger individuals as well.

Small hiatal hernias may not produce any symptoms.

When symptoms occur, they may include:

• Frequent heartburn
• Acid reflux
• Regurgitation of food or acidic fluid
• Chest discomfort
• Upper abdominal discomfort
• Difficulty swallowing
• Feeling full quickly
• Belching
• Bloating
• Symptoms that become worse after meals

Some people may notice that symptoms become worse when lying down or bending over.

No.

A hiatal hernia is a structural condition, while acid reflux occurs when stomach contents flow backward into the oesophagus.

However, a hiatal hernia can contribute to or worsen gastroesophageal reflux in some patients.

Therefore, persistent reflux symptoms may sometimes require evaluation for an underlying structural problem.

A doctor may first discuss your symptoms and medical history before deciding whether investigations are necessary.

Depending on the symptoms, diagnostic tests may include:

• Upper gastrointestinal endoscopy
• Barium swallow study
• Imaging scans
• Oesophageal manometry
• Other specialised tests for reflux

The appropriate investigation depends on the patient’s symptoms and clinical findings.

Yes. Not every hiatal hernia requires surgery.

If symptoms are mild, treatment may focus on controlling reflux and reducing factors that worsen symptoms.

Lifestyle measures may include:

• Eating smaller meals
• Avoiding lying down immediately after eating
• Maintaining a healthy weight
• Identifying foods that trigger reflux
• Avoiding smoking
• Limiting alcohol if it worsens symptoms
• Raising the head of the bed when recommended
• Avoiding tight clothing around the abdomen

Doctors may also prescribe medicines that reduce stomach acid or control reflux symptoms when appropriate.

Surgery may be considered when symptoms are persistent, severe or not adequately controlled with appropriate medical treatment.

It may also be recommended in selected patients with complications or certain types of larger or complicated hiatal hernias.

The decision should be based on the patient’s symptoms, investigations, overall health and type of hernia.

When surgery is required, it is often performed using a minimally invasive laparoscopic approach.

The surgeon moves the stomach back into its appropriate position and repairs the opening in the diaphragm. In selected cases, an anti-reflux procedure may also be performed to help control reflux.

The exact procedure depends on the patient’s condition.

Minimally invasive surgery may offer benefits such as smaller incisions and potentially faster recovery compared with traditional open surgery, although individual outcomes vary.

Occasional heartburn is common, but frequent or persistent symptoms should not simply be ignored.

Consult a doctor if you experience:

• Frequent heartburn
• Difficulty swallowing
• Persistent chest or upper abdominal discomfort
• Recurrent food regurgitation
• Unexplained weight loss
• Vomiting
• Symptoms that interfere with sleep or daily activities
• Reflux that does not improve with appropriate treatment

Difficulty swallowing, vomiting blood, black stools or severe chest pain require prompt medical evaluation.

The course of a hiatal hernia varies from person to person. Some remain stable and cause few or no symptoms, while others may experience worsening reflux or complications.

Regular medical evaluation is particularly important when symptoms are persistent or changing.

Long-standing reflux should not always be treated as simple acidity.

Repeated exposure of the oesophagus to stomach acid can cause inflammation and, in some patients, other complications.

If reflux symptoms are frequent or do not respond adequately to treatment, your doctor may recommend further evaluation to identify the underlying cause.

The appropriate treatment for a hiatal hernia depends on the type and severity of the condition and the symptoms it causes.

Dr. Bhushan Chittawadagi specialises in advanced gastrointestinal and laparoscopic surgery and can evaluate patients with reflux-related and complex GI conditions to determine an appropriate treatment approach.

A hiatal hernia does not always require surgery. Many people with small or uncomplicated hernias can manage their symptoms with lifestyle changes and appropriate medical treatment.

However, persistent reflux, swallowing difficulty, chest discomfort or other concerning symptoms should be evaluated rather than repeatedly treated as ordinary acidity.

With proper diagnosis, patients can understand the cause of their symptoms and choose an appropriate treatment plan based on their individual condition.