Hiatus Hernia

What is a Hernia?

A hernia occurs when an organ or tissue pushes through a weakness in the surrounding muscle or tissue wall. Hernias can develop in several locations throughout the body. The most common site is the groin, where inguinal and femoral hernias form, but they can also occur around the navel (umbilical hernia), through previous surgical scars (incisional hernia), or in the upper abdomen between the breastbone and belly button (epigastric hernia). Each type has its own causes, risk factors, and management pathway.

When a hernia involves the digestive tract and produces gastrointestinal symptoms, your GP may refer you to a gastroenterologist for specialist assessment. Gastroenterologists are trained to diagnose a range of hernias and to manage those affecting the upper gastrointestinal system. This page focuses on one of the most commonly referred types: the Hiatus Hernia.

What is a Hiatus Hernia?

Your oesophagus, or food pipe, travels from your throat down through your chest and into your abdomen, passing through a small opening in the diaphragm called the hiatus. The diaphragm is the large, flat muscle that separates your chest cavity from your abdomen and plays an essential role in breathing. Normally, this opening is just wide enough to allow the oesophagus to pass through, while keeping the stomach firmly below.

A hiatus hernia, sometimes written as hiatal hernia, occurs when part of the stomach pushes up through this opening and into the chest cavity. When the gap in the diaphragm is larger than it should be, the stomach can shift position, which may interfere with the mechanism that keeps stomach contents from travelling back up the oesophagus.

Types of Hiatus Hernia

Hiatus hernias are classified according to which part of the stomach moves through the diaphragm and how it does so.

Sliding Hiatus Hernia

This is the most common type. The upper portion of the stomach, which is connected to the oesophagus, slides up through the diaphragm into the chest. As the name suggests, this part of the stomach can move back and forth through the opening, which is why symptoms often vary with posture and activity.

Paraesophageal Hernia

In this type, a lower section of the stomach that is not connected to the oesophagus pushes up through the diaphragm alongside the oesophagus. Unlike a sliding hernia, this portion of the stomach tends to remain in the chest even when lying down. While less common, a paraesophageal hernia can carry a higher risk of complications and may require surgical attention.

Combined Hiatus Hernia

Some people have features of both types, where the upper and lower portions of the stomach have moved into the chest cavity. In rare cases, other abdominal organs such as part of the small bowel may also be involved.

Who is at Risk?

The exact cause of a hiatus hernia is not always clear. In many cases, a gradual weakening of the diaphragm muscle around the hiatus allows the stomach to shift position over time. Certain factors are known to increase the likelihood of developing a hiatus hernia. Being over 50 years of age, living with obesity, and a history of heavy lifting or repeated straining, such as during chronic coughing or straining to pass bowel motions, are all recognised risk factors. Some people are born with a larger than usual opening in the diaphragm, which can also predispose them to the condition.

Symptoms of a Hiatus Hernia

Many people with a hiatus hernia have no symptoms at all and are unaware they have the condition. When symptoms do occur, they are most often related to gastro-oesophageal reflux disease, commonly known as GORD or reflux. This happens when stomach acid moves back up the oesophagus, causing heartburn, a sour taste in the mouth, or discomfort behind the breastbone.

Other symptoms that may be associated with a hiatus hernia include chest pain, difficulty or discomfort when swallowing, a persistent cough, shortness of breath, nausea or vomiting, and bad breath or gum problems related to ongoing reflux. It is important to note that chest pain and severe shortness of breath can be signs of serious conditions unrelated to a hernia. If you experience sudden or severe chest pain or breathing difficulty, seek emergency medical attention immediately.

When should you see a doctor?

You should speak with your GP if you notice symptoms that may suggest a hiatus hernia, particularly if heartburn or reflux is affecting your daily life, if over-the-counter remedies are not providing adequate relief, or if you are vomiting frequently. Symptoms that are worsening over time also warrant medical review. Severe abdominal pain should be treated as a medical emergency, as it may indicate a serious complication such as a twisted or trapped bowel.

How is a Hiatus Hernia diagnosed?

Your GP will begin with a review of your symptoms and medical history, followed by a physical examination. If a hiatus hernia or GORD is suspected, you may be referred to a gastroenterologist for further investigation.

Diagnostic tests that may be used include imaging studies such as an X-ray, CT scan, or ultrasound to visualise the position of the stomach and surrounding structures. An endoscopy, where a thin flexible camera is guided through the mouth to examine the oesophagus and stomach, is often the most informative test and allows the specialist to assess for reflux-related damage at the same time. In some cases, manometry (a test measuring the pressure and function of the oesophageal muscles) and pH monitoring (which measures acid levels in the oesophagus over a 24-hour period) may also be recommended.

How is a Hiatus Hernia treated?

Treatment depends on the type of hernia, the severity of symptoms, and your overall health. Not all hiatus hernias require active treatment; for those without significant symptoms, monitoring and lifestyle modification may be all that is needed.

Lifestyle modifications

Simple changes to daily habits can significantly reduce reflux symptoms associated with a hiatus hernia. Eating smaller meals more frequently rather than large meals, avoiding eating in the two hours before going to sleep, and elevating the head of your bed can all help limit the movement of stomach acid into the oesophagus. Avoiding foods and drinks that are known to worsen reflux, such as fatty or spicy foods, can also provide relief. Where weight is a contributing factor, dietary changes to support a healthy weight are an important part of management. Consulting an accredited practising dietitian can be a valuable step in addressing dietary contributors to reflux and hernia-related symptoms.

Medicines

Medicines that reduce the amount of acid produced by the stomach are commonly used to manage the reflux symptoms associated with a hiatus hernia. These are often the first treatment recommended and are effective at relieving heartburn and allowing any oesophageal inflammation to settle. Over-the-counter antacids can provide short-term relief by neutralising stomach acid, though these are generally best used for occasional symptoms. Your doctor or pharmacist can advise on the most suitable option for your circumstances.

Surgery

Surgery may be considered when symptoms are not adequately controlled by medication, when there is evidence of damage to the oesophagus, or in the case of a large or paraesophageal hernia where the risk of complications is higher. Surgical intervention for a hiatus hernia is performed by a gastroenterologist or upper gastrointestinal surgeon, as it involves the stomach and oesophagus rather than the abdominal wall.

The operation is carried out under general anaesthetic and typically involves returning the stomach and other displaced structures to their correct position in the abdomen, stitching the diaphragm opening to reduce its size, and in many cases wrapping the upper portion of the stomach around the lower oesophagus to reinforce the repair and reduce reflux. This procedure is most commonly performed using keyhole (laparoscopic) techniques, which generally allow for a quicker recovery.

Following surgery, most patients are able to go home within a day or two. A period of adjustment is normal, and you may need to eat slowly and chew food thoroughly while healing. Your surgeon will provide guidance on returning to normal activities. For large hernias, surgery may not always be immediately essential, but the risk of serious complications such as strangulation (where the blood supply to the stomach is cut off) increases if a large hernia is left without surgical repair over time.

As with any surgical procedure, there are potential risks and complications, which your surgeon will discuss with you in detail before you make a decision. These may include general surgical risks as well as those specific to this type of operation.

Potential complications of an untreated Hiatus Hernia

A hiatus hernia that is not appropriately managed can lead to complications over time. Ongoing reflux can cause inflammation of the oesophageal lining, a condition known as oesophagitis, which can lead to ulcers or bleeding. With prolonged acid exposure, some people develop a condition called Barrett’s oesophagus, where the lining of the oesophagus changes in a way that requires ongoing monitoring. In more serious cases, particularly with a paraesophageal hernia, the stomach may become twisted or have its blood supply cut off, which is a medical emergency requiring urgent surgery. A hernia may also contribute to bowel obstruction if digestive contents are unable to pass through normally.

Can a Hiatus Hernia be prevented?

While it is not always possible to prevent a hiatus hernia, particularly where there is an underlying structural predisposition, certain measures can reduce the risk. Maintaining a healthy weight and avoiding activities that place repeated, excessive strain on the abdominal muscles are among the most effective steps. Treating a chronic cough and avoiding constipation through adequate dietary fibre and hydration may also help reduce pressure on the diaphragm over time.

Seeking specialist care in Brisbane

If you have been referred by your GP, please contact our Brisbane practice directly to make an appointment or to discuss your referral.

If ongoing reflux, chest discomfort, or difficulty swallowing is affecting your quality of life, speak to your GP about a referral to the team at Queensland Gastroenterology, who are available to provide specialist assessment and guidance. A thorough evaluation will help clarify whether a hiatus hernia is present and what the most appropriate pathway forward looks like for your situation. Early assessment can make a meaningful difference in managing symptoms and reducing the risk of complications.