Hiatus Hernia

A hiatus hernia is present when part of the stomach slides up through the opening in the diaphragm into the chest. It is very common, particularly after the age of 50, and most people with one never know.

There are two main kinds. A sliding hernia, by far the most common, mainly contributes to acid reflux. A para-oesophageal hernia, where part of the stomach rolls up beside the gullet, is less common but can twist or become trapped, and is the type more often repaired.

Symptoms

• Heartburn and acid or food coming back up, worse on bending or lying down
• Feeling full quickly, bloating and belching
• Chest or upper abdominal pain after meals
• Difficulty swallowing
• Breathlessness or palpitations after eating with large hernias
• Iron deficiency anaemia from slow bleeding of erosions in the hernia
• A chronic cough or hoarse voice

Causes and risk factors

The opening in the diaphragm widens and the ligaments that anchor the junction of gullet and stomach weaken with age. Anything that raises pressure in the abdomen adds to this: obesity, pregnancy, chronic cough, constipation with straining and heavy lifting. Previous surgery in the area and, rarely, injury or a congenital weakness play a part. Spinal curvature in older age is associated with large hernias.

How it is diagnosed

• Gastroscopy: Shows the hernia, measures its length and checks for oesophagitis, Barrett's change and erosions.
• Barium swallow: Outlines the anatomy and is especially useful for large or para-oesophageal hernias.
• Oesophageal manometry and pH monitoring: Done before anti-reflux surgery to confirm reflux and check that the gullet's muscle works well enough.
• CT scan: Shows which organs lie in the chest with giant hernias, and is the test for suspected twisting.

Treatment options

• Lifestyle measures: Weight loss, smaller evening meals, raising the head of the bed and avoiding tight waistbands.
• Acid-suppressing medication: Proton pump inhibitors control reflux symptoms in most people with a sliding hernia.
• Laparoscopic hernia repair with fundoplication: The stomach is returned to the abdomen, the opening is narrowed with stitches and the top of the stomach is wrapped around the gullet. Nissen (full) or Toupet (partial) wraps are chosen according to the manometry result.
• Mesh reinforcement: Sometimes added for very large openings. Its benefit is debated and it carries its own rare complications.
• Watchful waiting: Reasonable for large hernias with no symptoms in frail or older patients.

When it is urgent

Sudden severe chest or upper abdominal pain with retching but inability to vomit may mean the stomach has twisted, which is a surgical emergency. Vomiting blood or black stools also need immediate local care. Chest pain should never be assumed to come from a hernia until the heart has been checked.

Travelling to Türkiye for treatment

Planned keyhole repair travels well: one to two nights in hospital and about a week to ten days before flying. A sloppy or puréed diet is needed for four to six weeks, and some difficulty swallowing and bloating early on is expected, so ask for written dietary instructions. Have manometry and pH testing done before you commit, since surgery on the wrong patient gives poor results. A small sliding hernia with reflux controlled by tablets is not a reason to travel.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions