A hiatal hernia is the protrusion (or herniation) of the upper part of the stomach into the thorax through a tear or weakness in the diaphragm and into your chest region. Hiatal hernias often result in heartburn but may also cause chest pain or pain with eating. The most common cause is obesity. The diagnosis is often made by endoscopy or medical imaging.
A paraesophageal hiatal hernia occurs when a portion of the stomach protrudes through an opening in the diagram into the chest. The hernia then lies alongside the esophagus. Paraesophageal hernias tend to gradually increase in size leading to the protrusion of other abdominal organs into the chest.
This is the most common type of hiatal hernia and takes place when the connection between the esophagus and the stomach shifts upward, surpassing the diaphragm, thereby often pulling a section of the stomach into the chest cavity.
Because the hiatal hernia protrudes into the chest rather than abdominal wall, there is no visible bulge as with an abdominal hernia. Diagnosis of a hiatal hernia requires upper GI endoscopy, a barium swallow study, an MRI, or computerized tomography (CT) scan.
The most common symptom of hiatal hernia is reflux of gastric (stomach) contents into the esophagus, which can lead to chronic heartburn, one of the underlying causes of gastroesophageal reflux disease (GERD). Aside from experiencing heartburn and swallowing difficulties, certain severe types of hiatal hernia can result in limited blood flow to the stomach, which constitutes a surgical emergency.
For some patients, hiatal hernias are asymptomatic and require no treatment. Sliding hiatal hernias presenting with symptoms of GERD symptoms are typically treated with medications such as antacids, histamine-2 blockers and proton pump inhibitors (PPIs). For others, surgical repair may be recommended.
For paraesophageal hernias and very large sliding hernias, surgical repair may be needed. Various minimally invasive techniques, notably a Nissen Fundoplication, are used to successfully treat these conditions.