What causes hiatus hernia and how common is it?
The
exact number of people with a hiatus hernia is not known as many people
with a hiatus hernia do not have symptoms. However, they are thought to
be common. Some studies suggest that up to a third of people develop a
hiatus hernia sometime in their life, most commonly in middle age. Many
are small.
The cause of hiatus hernia is not clear. It is
thought that most develop in people over the age of 50. It may be that
the diaphragm weakens with age and allows part of the stomach to
protrude through the hole in the diaphragm. Factors which increase the
pressure in the abdomen such as regular coughing, weight lifting, or
obesity may increase the risk of developing a hiatus hernia.
(There
is a rare type of hiatus hernia which occurs in newborn babies due to a
congenital defect of the stomach or diaphragm. This is not dealt with
further in this leaflet.)
What are the symptoms of hiatus hernia?
Often there are none
Many people with a hiatus hernia have no symptoms.
Acid reflux symptoms
The hernia itself does
not cause symptoms. However, if you have a hiatus hernia, the factors
that normally prevent stomach acid from refluxing into the oesophagus
may not work so well. The sphincter may not work properly, and the
normal pressure of the diaphragm on the oesophagus is lost. Therefore,
you are more prone for acid in the stomach to reflux (regurgitate) into
your oesophagus. The refluxed acid can cause inflammation of the lower
part of the oesophagus which can cause one or more of the following
symptoms:
-
Heartburn is the main symptom. This is a
burning feeling which rises from the upper abdomen or lower chest up
towards the neck. (It is confusing as it has nothing to do with the
heart!)
-
Other common symptoms include: pain in the upper abdomen and
chest, feeling sick, an acid taste in the mouth, bloating, belching,
and a burning pain when you swallow hot drinks. Like heartburn, these
symptoms tend to come and go, and tend to be worse after a meal.
-
Some uncommon symptoms may occur. If any of these symptoms
occur it can make the diagnosis difficult as these symptoms can mimic
other conditions. For example:
- A persistent cough, particularly
at night, sometimes occurs. This is due to the refluxed acid irritating
the trachea (windpipe). Asthma symptoms of cough and wheeze can
sometimes be due to acid reflux.
- Other mouth and throat symptoms sometimes occur such as gum
problems, bad breath, sore throat, hoarseness, and a feeling of a lump
in the throat.
- Severe chest pain develops in some cases (and may be mistaken for a heart attack).
Note: most people with acid reflux do not have a hiatus hernia.
Also, most people with a hiatus hernia do not have symptoms of acid
reflux. (If you have a hiatus hernia it does not necessarily mean that
the sphincter between the oesophagus and stomach does not work so well.
It is just that having a hiatus hernia makes you more prone to have a
poorly functioning sphincter and more prone to develop acid reflux
symptoms.)
However, people with a hiatus hernia who do get
reflux, on average, tend to get more severe symptoms and problems
associated with acid reflux. This may be because with a hiatus hernia,
any acid that gets into the oesophagus is more likely to remain in
contact with the lining of the oesophagus for longer compared to people
without a hiatus hernia.
See separate leaflet called 'Acid Reflux and Oesophagitis' for more details.
How is a hiatus hernia diagnosed?
A hiatus
hernia may be diagnosed if you have tests for symptoms of reflux.
Endoscopy is the common test. This is where a thin, flexible telescope
is passed down the oesophagus into the stomach. This allows a doctor or
nurse to look inside. A hiatus hernia may be seen. A special X-ray test
called a barium swallow is another more accurate way to confirm the
presence of a hiatus hernia.
What is the treatment of hiatus hernia?
- If you have no symptoms, you do not need any treatment. The hiatus hernia itself causes no harm.
- If you have reflux symptoms, then treatment is the same as for any
other cause of reflux symptoms. Treatment includes: lifestyle factors
such as losing weight if you are overweight, antacids and
acid-suppressing drugs. See the leaflet called 'Acid Reflux and Oesophagitis' for details of treatment.
- Rarely, a hiatus hernia causes severe symptoms of reflux which are
not helped so well with medication. Therefore, an operation is
occasionally advised. During this operation the stomach is put back
into the correct position, and the weakened diaphragm around the lower
oesophagus is tightened.
What are the possible complications of a hiatus hernia?
Possible
complications may occur if you have long-term reflux of acid into the
oesophagus which occurs in some cases. These include:
-
Stricture.
If you have severe and long-standing inflammation it can cause scarring
and narrowing (a stricture) of the lower oesophagus. This is uncommon.
-
Barrett's oesophagus. In this condition the cells that line
the lower oesophagus change. The changed cells are more prone than
usual to become cancerous. (About 1 or 2 people in 100 with Barrett's
oesophagus develop cancer of the oesophagus.)
-
Cancer. Your risk of developing cancer of the oesophagus is
slightly increased compared to the normal risk if you have long-term
acid reflux. This small increased risk is slightly higher still in
people with reflux plus a hiatus hernia. This is because reflux
problems, on average, tend to be more severe in people with a hiatus
hernia compared to those without a hiatus hernia.
But note: it has to be stressed that most people with reflux or
hiatus hernia do not develop any of these complications. They are
uncommon. Tell your doctor if you have pain or difficulty (food
'sticking') when you swallow which may be the first symptom of a
complication.
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 25 Jul 2008
