GI Conditions
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      1. VCT Resource Library
      2. GI Conditions

      Hiatal Hernia

      Brief Overview: According to Mount Sinai, “Hiatal hernia is a condition in which part of the stomach extends through an opening of the diaphragm into the chest.” There are 2 main types of hiatal hernias – sliding (most common) and paraesophageal.

      Prevalence: The prevalence of hiatal hernias is estimated to be 20% in the US.

      Etiology: The exact cause is unknown.

      Risk Factors:

      • Age > 50 years old
      • Obesity
      • Smoking
      • Trauma
      • Excess abdominal pressure – chronic coughing, constipation/straining to have a bowel movement, frequent vomiting, intense exercise/heavy lifting

      Commonly Associated Conditions:

      • GERD
      • Esophagitis
      • Esophageal stricture
      • Barrett’s Esophagus

      Common Medications:

      • Medication to treat associated GERD

      Common Labs, Imaging, and Tests:

      • Upper endoscopy
      • X-ray, MRI, CT
      • Barium swallow
      • Esophageal manometry

      Common Symptoms:

      • Often asymptomatic
      • GERD symptoms – acid reflux, regurgitation, dysphagia

      Common Treatments:

      • Sometimes no treatment is needed
      • Treatment of associated GERD
      • Surgery may be indicated for some

      Physical Findings:

      • Typically normal physical exam
      • This is typically an incidental finding on imaging studies done for other reasons

      Potential Complications and Contraindications:

      • Pulmonary aspiration
      • Pneumonia
      • Anemia
      • Strangulation of the hernia – rare emergency

      General Health and Lifestyle Guidance:

      • Smoking cessation
      • Eat smaller, more frequent meals
      • Weight loss may be recommended
      • Elevate your head of the bed, avoid lying down immediately after eating
      • Wear loose-fitting clothing to reduce abdominal pressure

      Suggested Questions to Ask Patients:

      • Do you often feel heartburn or food coming back up?
      • Do symptoms worsen after meals or at night?
      • Are you taking any medications for reflux or acid control?
      • Have you had imaging or an endoscopy done in the past?

      Suggested Talking Points:

      • Make sure to follow all recommended treatment plans and follow up as directed by your healthcare provider
      • Make sure to report any new, worsening, or persistent symptoms to your healthcare provider

      Sources: