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The stomach is normally in a position below the diaphragm (the muscle that separates the chest from the abdomen). A hiatal hernia is present when part of the stomach bulges into the chest.

The diaphragm has an opening that allows the oesophagus to pass through before it joins the stomach. A hiatal hernia occurs when this opening enlarges due to a weakening of the diaphragm, thus allowing part of the stomach to rise upwards into the chest. This condition is more common amongst people who are overweight.

Patients may not have symptoms and the condition is only discovered when an investigation is performed, such as a gastroscopy.

Symptoms may include:

  1. Heartburn
    •    Due to acid reflux from the stomach into the esophagus
  2. Dysphagia
    •    Difficulty in swallowing food or a sensation of food stuck behind the chest
  3. Vomiting

It is advisable to seek medical attention when you experience any of the above symptoms. There are many other causes to account for the symptoms, it will be best to have these symptoms evaluated.

Most cases of hiatal hernia do not require any treatment.

For those with symptoms of reflux, treatment is mostly with medication and lifestyle modification.

Surgery may be required in a minority of cases to address the problem of obstruction due to the hiatal hernia. This operation is called Para-oesophageal Hernia Repair. This is most commonly performed via a laparoscopic or keyhole.

Whilst not completely preventable, constipation, straining when passing urine, carrying heavy weights or a chronic cough may aggravate the condition.


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