For patient education and awareness
Symptoms such as frequent heartburn, chest discomfort after meals, or worsening reflux on lying down are commonly attributed to acidity. In some individuals, however, these symptoms may be related to a hiatal hernia, a condition that is often under-recognised.
According to Dr. Rajeev Kapoor, senior gastrointestinal and laparoscopic surgeon based in Chandigarh, hiatal hernia is frequently mistaken for routine acid reflux, which may delay appropriate diagnosis and management.
1. What Is a Hiatal Hernia?
A hiatal hernia occurs when a portion of the stomach moves upward through the diaphragm, the muscle that separates the chest cavity from the abdominal cavity. This displacement can interfere with normal swallowing and acid control mechanisms.
Types of Hiatal Hernia
- Sliding Hiatal Hernia
The most common type, where the stomach and lower part of the oesophagus slide into the chest. - Paraesophageal Hiatal Hernia
A less common but potentially more serious type, where part of the stomach pushes up beside the oesophagus.
2. What Causes a Hiatal Hernia?
Hiatal hernias usually develop due to weakening of the diaphragm or increased pressure within the abdomen.
Contributing factors may include:
- Chronic acid reflux (GERD)
- Obesity or sudden weight gain
- Pregnancy
- Persistent coughing or straining (e.g., constipation)
- Age-related weakening of muscles
- Heavy lifting over long periods
As Dr. Kapoor notes, both structural factors and lifestyle-related stress on the abdomen play a role in the development of hiatal hernia.
3. Common Symptoms
Hiatal hernia symptoms often overlap with those of acid reflux or gastritis. These may include:
- Heartburn or burning sensation in the chest
- Regurgitation of food or sour fluid
- Difficulty or discomfort while swallowing
- Chest discomfort after bending or lying down
- Chronic cough or throat irritation
In some cases, more serious symptoms such as vomiting blood or black stools may occur and require urgent medical evaluation.
4. How Is Hiatal Hernia Diagnosed?
Diagnosis is usually confirmed through one or more of the following tests:
- Upper gastrointestinal endoscopy – allows direct visualisation of the hernia and assessment of reflux-related damage
- Barium swallow X-ray – shows the position of the stomach and oesophagus
- Oesophageal manometry – measures muscle strength and coordination during swallowing
Endoscopy is commonly used to evaluate both the presence of hiatal hernia and associated reflux disease.
5. Treatment Options for Hiatal Hernia
Treatment depends on the size of the hernia and severity of symptoms.
a. Lifestyle and Medical Management
Often recommended for small or mildly symptomatic hiatal hernias:
- Eating smaller, frequent meals
- Avoiding lying down for at least 2–3 hours after meals
- Elevating the head while sleeping
- Avoiding trigger foods such as spicy foods, caffeine, and alcohol
- Maintaining a healthy body weight
- Medications such as antacids or proton pump inhibitors (PPIs), as prescribed
b. Surgical Management
Surgery may be advised for patients with persistent symptoms, complications, or large hernias.
Laparoscopic hiatal hernia repair generally involves:
- Repositioning the stomach into the abdominal cavity
- Narrowing the diaphragmatic opening
- Reinforcement with mesh when indicated
- Often combining the repair with fundoplication to reduce acid reflux
The choice of treatment is individualised based on clinical assessment.
6. Recovery and Outlook
Post-treatment recovery varies depending on the approach used.
General recovery expectations may include:
- Short hospital stay
- Gradual progression from liquid to soft diet
- Return to routine activities within days to weeks
- Long-term symptom control in most patients with appropriate treatment
7. When to Seek Immediate Medical Attention
Urgent medical evaluation is required if there is:
- Sudden severe chest or abdominal pain
- Persistent vomiting
- Difficulty breathing or swallowing
- Black or tarry stools, which may indicate bleeding
Conclusion
Hiatal hernia is a common digestive condition that can be effectively managed when diagnosed early. Accurate evaluation helps differentiate it from routine acidity and guides appropriate treatment. Modern medical and surgical approaches offer good symptom control and improved quality of life for most patients.
This information is intended for general patient education and does not replace personalised medical consultation.
Frequently Asked Questions (FAQs): Hiatal Hernia
1. What is a hiatal hernia?
A hiatal hernia occurs when a part of the stomach moves upward through the diaphragm into the chest cavity. The diaphragm normally helps keep the stomach in place below the chest.
2. Is a hiatal hernia common?
Yes. Hiatal hernia is a common condition, especially in adults over the age of 40. Many people may have a small hiatal hernia without noticeable symptoms.
3. What are the main types of hiatal hernia?
There are two main types:
-
Sliding hiatal hernia, where the stomach and lower oesophagus move up into the chest
-
Paraesophageal hiatal hernia, where part of the stomach pushes up beside the oesophagus and may require closer monitoring
4. What causes a hiatal hernia?
Hiatal hernia may develop due to:
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Weakening of the diaphragm with age
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Increased abdominal pressure from obesity, pregnancy, or straining
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Chronic coughing or heavy lifting
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Long-standing acid reflux
5. Can a hiatal hernia cause acid reflux?
Yes. A hiatal hernia can interfere with the normal valve between the stomach and oesophagus, making acid reflux (GERD) more likely.
6. What symptoms are commonly associated with hiatal hernia?
Symptoms may include:
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Heartburn or chest burning
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Regurgitation of food or sour liquid
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Difficulty swallowing
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Chest discomfort after lying down or bending
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Chronic cough or throat irritation
Some people may have no symptoms at all.
7. How is a hiatal hernia diagnosed?
Diagnosis may involve:
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Upper gastrointestinal endoscopy
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Barium swallow X-ray
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Oesophageal manometry
These tests help assess the size of the hernia and related reflux damage.
8. Does every hiatal hernia require treatment?
No. Small hiatal hernias without symptoms may not require specific treatment. Management depends on symptom severity and associated complications.
9. Can lifestyle changes help manage hiatal hernia?
Yes. Measures such as eating smaller meals, avoiding lying down after eating, weight management, and avoiding trigger foods can help reduce symptoms.
10. What medications are used for hiatal hernia?
Medications do not repair the hernia but may help control symptoms. These include antacids and acid-reducing medicines such as proton pump inhibitors, prescribed by a doctor.
11. When is surgery required for hiatal hernia?
Surgery may be advised if symptoms persist despite medical treatment, or if complications such as severe reflux, bleeding, or large paraesophageal hernia are present.
12. What does hiatal hernia surgery involve?
Surgical repair typically involves repositioning the stomach, tightening the diaphragmatic opening, and sometimes performing fundoplication to reduce reflux. Many repairs are done using minimally invasive techniques.
13. Is hiatal hernia surgery safe?
Hiatal hernia surgery is a well-established procedure. As with all surgeries, there are risks, which should be discussed with the treating surgeon.
14. How long does recovery take after hiatal hernia surgery?
Recovery varies. Many patients resume light activities within a few days, while full recovery may take several weeks depending on individual factors.
15. When should I seek urgent medical care?
Immediate medical attention is required if you experience:
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Sudden severe chest or abdominal pain
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Persistent vomiting
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Difficulty breathing or swallowing
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Black or tarry stools
