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Hiatal hernia

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Diseases & Conditions  

When one part of the body protrudes through an opening into another part of the body, a hernia occurs. Hiatal hernias - also known as diaphragmatic hernias - form at the opening (hiatus) in diaphragm where the food pipe (esophagus) joins the stomach. When the muscle tissue around the hiatus becomes weak, the upper part of your stomach may bulge through the diaphragm into your chest cavity.


Sometimes a hiatal hernia becomes so large that as much as one-third or more of your stomach protrudes through your diaphragm. This can exert pressure on your lungs or diaphragm.

In addition, some large hiatal hernias may create friction that causes lesions (Cameron erosions) in your upper stomach. If severe, these lesions can bleed and lead to iron deficiency anemia from chronic blood loss.

Pain, bloating and possible obstruction of your esophagus may occur if the portion of your stomach that protrudes into the chest cavity becomes twisted. In rare cases, nearly your entire stomach may protrude into your chest cavity, causing restricted blood flow to your stomach. This can produce severe chest pain and difficulty swallowing. If this occurs, see your doctor without delay. You may require urgent surgical repair of the hernia.

The most common complication of hiatal hernia, however, is probably GERD. At one time it was thought that hiatal hernias caused most cases of GERD. Now doctors believe that usually only larger hiatal hernias play a role. Recurrent GERD itself can lead to complications, including:

  • Difficulty swallowing. Stomach acid backing up into your esophagus can cause inflammation and scarring. This narrows your esophagus, making it hard for you to swallow.

  • Barrett's esophagus. Occasionally, people with gastroesophageal reflux develop Barrett's esophagus from repeated and long-term exposure to stomach acid. In this condition, cells similar to those in the stomach lining develop in the lower esophagus — a process called metaplasia. If you have Barrett's esophagus, you're at increased risk of developing esophageal cancer. A gastroenterologist can advise you how best to manage the condition to lessen this risk.

  • Esophageal cancer. Most people with Barrett's esophagus don't develop esophageal cancer. However, the prognosis is often poor for those who do. The main symptom of an esophageal tumor is progressive difficulty with swallowing. At first, solid food may be hard to swallow. But as the tumor grows, you may even have difficulty swallowing liquids. Your esophagus may also become blocked, which can cause you to inhale (aspirate) food or liquid into the tube leading to your lungs (trachea). Eventually you may stop eating entirely, which can lead to weight loss and dehydration.

Hiatal hernia > 1 > 2 > 3 > 4

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