A hiatal hernia occurs when the upper part of the stomach pushes through the opening in the diaphragm (the muscle that separates the chest from the abdomen) where the esophagus normally passes. Many hiatal hernias are small and cause few or no symptoms, but larger or sliding hernias can disrupt the normal anti-reflux barrier and contribute to GERD.
Treatment depends on symptoms and may range from lifestyle and medication approaches similar to GERD management to surgical repair when symptoms are severe or complications develop.
Many people with hiatal hernias have no symptoms; when symptoms occur, they are often those of reflux, including heartburn, regurgitation, and chest discomfort, sometimes with difficulty swallowing or shortness of breath after large meals.
Call the office if you have persistent or worsening heartburn, difficulty swallowing, chest discomfort, or regurgitation despite lifestyle changes and medications, or if you have known hiatal hernia with new or changing symptoms.
Seek emergency care for sudden, severe chest or upper abdominal pain, repeated vomiting, black or bloody stools, inability to swallow, or signs of strangulated hernia (severe pain with vomiting, inability to pass gas or stool). These could signal a serious complication.
Hiatal hernias are often found on imaging or endoscopy done for reflux symptoms. Evaluation focuses on understanding symptom severity, ruling out complications, and determining whether medical or surgical treatment is appropriate.
Most hiatal hernias that cause typical reflux symptoms are managed with the same lifestyle and medication strategies used for GERD. Larger or paraesophageal hernias, or those causing significant symptoms or complications, may require surgical repair.
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