A hiatal hernia is medical conditions in which part of your stomach bulges into your chest cavity. Hiatal hernias are common, especially in older adults. Some people with a hiatal hernia do not know they have one unless their doctor discovers it incidentally while diagnosing or imaging another problem. Other people experience symptoms, such as heartburn. Doctors use imaging to detect hiatal hernias, and can suggest a course of treatment for patients whose hiatal hernias pose a problem.
A hiatal hernia is a condition in which the upper part of your stomach bulges through your diaphragm, which is a large, thin muscle that lies between your abdomen and your chest. Your diaphragm helps you breathe and it helps prevent acid from coming up into your esophagus, which is the tube that connects your mouth to your stomach.
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Normally, your stomach sits below your diaphragm. If you have a hiatal hernia, your stomach pushes through a small opening in your diaphragm, which makes it easier for acid to move upward (reflux) into your esophagus. Doctors refer to this leaking of stomach acid into your esophagus as gastroesophageal reflux disease (GERD).
GERD can cause a variety of symptoms, including:
- Heartburn
- Problems swallowing
- Nausea and/or vomiting
- Bad breath
- A dry cough
- Breathing problems
- Erosion of tooth enamel, particularly on back teeth
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People of all ages and both genders can develop a hiatal hernia, but it occurs more frequently in people over the age of 50. Hiatal hernia seems to occur more often in smokers and in overweight individuals.
A hiatal hernia is often the result of an increase in pressure in the abdominal cavity, which is the space in the middle of your body that holds your stomach, liver, pancreas, gallbladder, spleen, intestines, kidneys and bladder. Pressure can build up from severe coughing, vomiting, straining to have a bowel movement, and from heavy lifting or other physical strain. Pregnancy, obesity, and extra fluid in the abdomen can also cause a hiatal hernia. While there is a link between hiatal hernia and GERD, one condition does not seem to cause another.
There are two types of hiatal hernias:
- Sliding hiatal hernia – the stomach and the section of the esophagus adjoining the stomach slide up through the hiatus into the chest
- Paraesophageal hernias – the stomach and esophagus stay in their normal locations, but part of the stomach squeezes through the diaphragm to sit beside the esophagus
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