Hiatal Hernia Definition

A weakening in the diaphragm, the muscular wall that separates the thoracic cavity (chest) from the abdominal cavity, that allows part of the upper stomach to slide upward into the chest.

The weakening develops in the natural lapse in the diaphragm’s continuity, called the hiatus, that allows the esophagus to join the stomach. Hiatal hernia becomes more common with increasing age and often coexists with gastroesophageal reflux disorder (gerd). Most hiatal hernias do not present symptoms, though the GERD does.

The hiatal hernia can worsen the symptoms of GERD by forming a pocket that traps the refluxed gastric contents, intensifying the duration of exposure the esophageal mucosa experiences. Risk factors for hiatal hernia include pregnancy (which pressures the diaphragm) and obesity.

Barium swallow or esophagoscopy (endoscopic examination of the esophagus) can detect the presence of hiatal hernia. Unless there is risk for gastric or esophageal strangulation, in which a portion of the esophagus or stomach becomes pinched off on the thoracic side of the diaphragm, lifestyle modifications such as weight loss and medications to treat associated GERD can successfully manage hiatal hernia.

When there is a substantial risk for strangulation, such as with a large hernia, the gastroenterologist may recommend surgery to repair the hernia and prevent strangulation. Gastric or esophageal strangulation, though rare, requires emergency surgery.


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