by admin-blog-kh | June 18, 2026 5:13 am
A hiatal hernia is a common condition wherein the stomach’s upper part or other internal organs push upward or protrude through the diaphragm’s hiatus (an opening through which the oesophagus passes and connects with the stomach; it separates the abdomen and the chest cavity). Some hiatal hernias are asymptomatic, while some may require surgical intervention as they impact the daily lives of patients.
When the stomach pushes upward through the diaphragm, it causes laxity of the lower esophageal sphincter. This compromise of the lower oesophageal sphincter allows acid and gastric contents to flow back into the oesophagus, leading to gastroesophageal reflux disease (GERD)[1].
Hiatal hernias can be either acquired or congenital. Some people are born with a larger-than-normal hiatus opening, increasing their susceptibility to developing a hiatal hernia. The prevalence is higher among older adults due to loss of muscle elasticity and flexibility with age, causing muscle weakness, a possible factor for hiatal hernia development. Other factors include pregnancy, obesity, chronic obstructive pulmonary disease[2] or chronic constipation, which leads to an increase in intra-abdominal pressure. Any kind of trauma to the chest or stomach can damage the diaphragm, increasing the risk of hiatal hernias.
This article focuses on the causes, symptoms and diagnosis of hiatal hernias and treatment strategies that provide relief to patients.
There are four main types, as mentioned below:
Type 1: Sliding hiatal hernia is the most common type (~95%), wherein the gastro-oesophageal junction (where the oesophagus and stomach meet) slides up into the chest cavity.
Type II: Paraoesophageal hiatal hernia is less common than the sliding type, wherein the stomach pushes up into the mediastinum.
Type III: A combination of sliding and paraoesophageal hiatal hernia, wherein part of the gastro-oesophageal junction and the stomach protrude into the mediastinum.
Type IV: The stomach, along with another organ such as the spleen, colon or small intestine pushes towards the chest cavity.
Usually, hiatal hernias are asymptomatic; however, if a patient is symptomatic, they present with the following:
Less common symptoms include chronic cough, hoarseness, a feeling of fullness after eating small meals and shortness of breath. Paraoesophageal hernias can cause serious symptoms in which patients experience severe chest pain, vomiting, or signs of gastric obstruction.
Endoscopy: This technique allows visualization of the hiatus, oesophagus and stomach position. It aids in ruling out tumours and indicates the presence of oesophageal injury.
Manometry: This method assesses the function of the lower oesophageal sphincter and oesophageal muscle contractions to help exclude achalasia (a condition where the patient finds it difficult to move the food down the oesophagus), which can mimic the symptoms of reflux.
24-Hour pH test: This test is the gold standard for acid reflux diagnosis. The amount of acid that passes the gastro-oesophageal junction is identified by placing a probe 5 cm above the gastro-oesophageal junction. The obtained data are quantified using the DeMeester score based on several parameters: number of reflux episodes, the amount of time the oesophageal pH is less than 4, duration of the longest reflux episode and the number of reflux episodes that last for more than 5 minutes. If the score is 14.7, it indicates gastro-oesophageal reflux.
The choice of treatment depends on the hernia type and size, complications and severity of symptoms. For example, a sliding hernia can be managed with lifestyle changes and medicines. Whereas a paraoesophageal hernia requires surgical intervention owing to the risk of complications.
Medications such as proton pump inhibitors like omeprazole, antacids and H2 receptor blockers like famotidine are effective for sliding hernias and help to reduce acid reflux symptoms[5]. However, they are unable to prevent the complications associated with paraoesophageal hernia.
According to gastrointestinal surgeons, surgery is considered for patients where lifestyle modifications or medications do not alleviate the symptoms or when acid reflux damages the oesophageal lining. The surgery is either open (a large incision) or done laparoscopically and may involve three approaches: (1) pulling back the stomach in the abdomen and reducing the size of the opening in the diaphragm; (2) removal of the hernia only and (3) reconstruction of the sphincter that connects the stomach and the oesophagus.
Paraoesophageal hernias may present with gastric volvulus (twisting of the stomach on itself, causing gastric obstruction), which is considered a surgical emergency. Currently, surgery is recommended for all symptomatic paraoesophageal hernias and larger hernias in patients less than 60 years and who are asymptomatic.
The methods used for hiatal hernia treatment as discussed below:
Nissen fundoplication (360° wrap): In this procedure, the upper part of the stomach is wrapped around the lower part of the oesophagus to increase the strength of the gastro-oesophageal sphincter to prevent the gastric contents from flowing back into the oesophagus.
Partial fundoplication: This method is preferred when oesophageal motility is poor (the oesophagus is unable to pass food or fluids from the mouth to the stomach). Unlike the 360° wrap, a 180° or 250° wrap is created to prevent oesophageal obstructions. The two most common methods of partial fundoplication are as follows:
Transoral incisionless fundoplication (TIF): This method is useful for restoring valve function and preventing the gastric contents from flowing back into the oesophagus. It involves the insertion of the endoscope through the mouth, and fasteners are placed to create a new valve by folding the upper part of the stomach and securing it to the lower part of the oesophagus. According to gastrointestinal surgeons, this method can be combined with hiatal hernia repair by repairing the defect in the diaphragm that allows the stomach to protrude. This method is minimally invasive and does not involve any external incision. The recovery time is faster, and the patients have reported reduced episodes of acid reflux and decreased need for medications.
Magnetic sphincter augmentation (MSA) or the LINX system: In this method, magnetic titanium beads are placed around the lower oesophageal sphincter; this enhances the closure of the sphincter and prevents acid reflux. While performing this procedure, a hiatal hernia can also be repaired.
EndoStim system: This can be used to treat GERD by using electrical impulses to strengthen the lower oesophageal sphincter, thereby preventing backflow of acid into the oesophagus.
Mesh technology: The principle of this technology is reinforcement of the oesophageal hiatus and to bridge or close the opening in the diaphragm, reducing hiatal hernia recurrence rates; however, the risk of mesh migration (moves out of place and causes complications such as stomach blockage) and complications such as erosion and fibrosis have been observed with permanent synthetic meshes (made of polypropylene). Bioabsorbable meshes (e.g., made of poly-4-hydroxybutyrate [P4HB]) have lowered recurrence rates, and the use of biosynthetic meshes (e.g., Phasix ST) has reported no mesh erosion and symptom relief, although the recurrence rates varied.
Novel promising technologies: The laparoscopic “Tunnel” approach has shown promising results in hiatal hernia treatment by preserving the vagus nerve while enhancing post-surgery outcomes and patients’ quality of life. Machine learning applications, robotic surgery advancements, such as haptics (sense of touch), and biologic therapies (platelet-rich plasma), are emerging technologies showing promise; however, more studies are required for their widespread adoption in hiatal hernia treatment.
A hiatal hernia is a common condition where the stomach or other internal organs protrude through the opening in the diaphragm into the chest cavity. This causes symptoms such as heartburn, acid reflux and difficulty swallowing. Modern medical and surgical advancements, including the use of new materials and minimally invasive procedures, have shown that management of hiatal hernia has evolved.
If you experience persistent reflux, chest discomfort, or swallowing difficulties, early evaluation can prevent complications and improve quality of life. Kauvery Hospital, with expert gastroenterology and surgical teams[8] across Chennai, Hosur, Salem, Tirunelveli, and Trichy, offers advanced diagnosis and personalized treatment options for comprehensive hiatal hernia care[9].
What is a hiatal hernia?
A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity through the oesophageal opening. It can weaken the lower oesophageal sphincter and lead to acid reflux.
What causes a hiatal hernia?
Hiatal hernias can be caused by age-related muscle weakness, obesity, pregnancy, chronic coughing, constipation, increased abdominal pressure, or a congenital enlarged diaphragmatic opening.
What are the common symptoms of a hiatal hernia?
Common symptoms include heartburn, acid reflux, regurgitation, difficulty swallowing, chest discomfort, bloating, and belching. Some people may not experience symptoms.
Can a hiatal hernia cause GERD?
Yes. A hiatal hernia can weaken the lower oesophageal sphincter, allowing stomach acid to flow back into the oesophagus, causing gastroesophageal reflux disease (GERD).
What is the difference between sliding and paraoesophageal hiatal hernia?
Sliding hernia is the most common type where the gastro-oesophageal junction moves into the chest. Paraoesophageal hernia is less common but more dangerous, as part of the stomach pushes beside the oesophagus.
How is a hiatal hernia diagnosed?
Diagnosis may involve upper endoscopy, oesophageal manometry, and a 24-hour pH test to measure acid reflux. CT scans may be used in complicated cases.
When is surgery required for a hiatal hernia?
Surgery is considered when symptoms do not improve with lifestyle changes and medications, when GERD causes oesophageal damage, or in paraoesophageal hernias with risk of obstruction.
What is fundoplication surgery?
Fundoplication is a procedure where the upper part of the stomach is wrapped around the lower oesophagus to strengthen the sphincter and prevent acid reflux. It can be complete (Nissen) or partial.
Can a hiatal hernia go away on its own?
No. A hiatal hernia is not resolved on its own. However, mild sliding hernias can often be managed with lifestyle changes and medications.
Is hiatal hernia surgery safe?
Yes. Modern laparoscopic techniques are generally safe and effective[10], with faster recovery and low recurrence rates when performed by experienced surgeons.
Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet, Radial Road & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and paediatric trauma care.
Chennai Alwarpet – 044 4000 6000 • Chennai Radial Road – 044 6111 6111 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4077777 • Trichy – Tennur – 0431 4022555 • Maa Kauvery Trichy – 0431 4077777 • Kauvery Cancer Institute, Trichy – 0431 4077777 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 68011
Source URL: https://www.kauveryhospital.com/blog/gastroenterology/hiatal-hernia/
Copyright ©2026 Kauvery Blog unless otherwise noted.