What is a Sliding Hiatal Hernia?
Have you ever stopped to consider the anatomy of your stomach and esophagus? Normally the stomach and the junction of the stomach and the esophagus, called the gastroesophageal junction, lie below the diaphragm, while the remainder of the esophagus lies above it. With a common condition called sliding hiatal hernia, the stomach and the gastroesophageal junction slide up through the hole in the diaphragm into the chest. What causes a sliding hiatal hernia, and how is it diagnosed and treated?
What Causes a Sliding Hiatal Hernia?
A sliding hiatal hernia happens when the diaphragmatic muscles that hold the esophagus in place weaken. This allows the lower esophagus and stomach to slide through the hole in the diaphragm when pressure in the abdomen increases from physical exertion, coughing, bending over or when too much pressure is applied to the abdomen by wearing constrictive clothing.
Diaphragmatic muscles weaken with age, so it is not surprising that a sliding hiatal hernia is more common in people over the age of 40. Obesity also increases the risk of a hiatal hernia since a large tummy puts pressure on the diaphragm. People who smoke, are pregnant or who have congenital abnormalities of the diaphragm are also at higher risk.
Symptoms of a Sliding Hiatal Hernia
Surprisingly, most small sliding hiatal hernias cause few symptoms or are completely asymptomatic. When they do cause symptoms, the most common is a reflux of acid from the stomach back into the esophagus, a condition known as GERD. Some people with a sliding hiatal hernia have frequent hiccups or belch a lot, but serious symptoms with this type of hernia are uncommon. A very large sliding hiatal hernia can cause chest discomfort or difficulty swallowing.
Diagnosing a Sliding Hiatal Hernia
Many people have a small sliding hiatal hernia and don’t know it because they usually have few symptoms. When a sliding hiatal hernia is suspected because of symptoms such as GERD, it may show up on a special x-ray called a barium swallow. If it doesn’t show up on a barium swallow, a doctor may order an endoscopy, a procedure that looks into the esophagus and stomach using a special scope.
How is a Sliding Hiatal Hernia Treated?
Sliding hiatal hernias that cause no symptoms require no treatment. If a person experiences reflux symptoms like heartburn, a sour taste in the mouth, or frequent belching, they can usually be relieved by taking simple measures. These include not eating before bedtime, eating smaller meals, avoiding constrictive clothing, not lifting heavy objects, not smoking, avoiding constipation, elevating the head of the bed several inches, and not eating foods that aggravate the symptoms, especially spicy foods, alcohol, and caffeine.
If acid reflux is a problem, doctors sometimes prescribe antacids or medications that reduce acid production by the stomach - such as H2 blockers. Surgery may be necessary for a large, symptomatic hiatal hernia that doesn’t respond to other treatments.
The Bottom Line?
Sliding hiatal hernias are common and frequently cause no symptoms. If you suspect you have one, see your doctor for an evaluation.
Professional Guide to Diseases. Ninth edition. 2009. Lippincott, Williams and Wilkins. pages 251-253.
EMedicine website. “Hiatal Hernia”.
Feldman: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease, 9th ed. Chapter 24.