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A hiatal hernia occurs when a part of the stomach pushes up through an opening in the diaphragm, the muscle that separates the chest from the abdomen.
Normally, the oesophagus (food pipe) passes through a small gap (hiatus) in the diaphragm to connect to the stomach. In a hiatal hernia, the stomach bulges through this gap into the chest area.
The symptoms of a hiatal hernia can vary depending on its size and type. Some individuals may not have noticeable symptoms, while others may encounter discomfort.
Several factors can contribute to the development of a hiatal hernia by weakening the diaphragm or increasing abdominal pressure. The most common are:
The diaphragm muscles weaken with age, making it easier for the stomach to push through the hiatus. Individuals over 50 are at higher risk for hiatal hernias.
Excess body weight increases pressure on the abdomen, which can cause the stomach to be pushed up through the diaphragm, leading to a hiatal hernia.
Some individuals are born with a larger-than-normal hiatus, which can make it easier for the stomach to protrude through the diaphragm, even without other contributing factors.
Activities that involve repeated straining or heavy lifting can raise abdominal pressure, which may lead to the development of a hiatal hernia. This includes physical exertion at work or while exercising.
Persistent coughing from conditions such as chronic obstructive pulmonary disease (COPD) or smoking can exert repeated pressure on the diaphragm and abdomen, contributing to the risk of a hiatal hernia.
During pregnancy, the growing uterus can increase abdominal pressure, which may push the stomach through the hiatus. Hiatal hernias in pregnancy are usually temporary but can cause symptoms during this period.
Hiatal hernias are generally classified into two main types:
The most common type occurs when both the stomach and the lower part of the oesophagus slide up into the chest via the diaphragm. The hernia tends to move in and out of the chest cavity, especially when lying down or after a meal.
In this less common but more serious type, part of the stomach pushes through the hiatus and sits next to the oesophagus without sliding back down. Unlike the sliding hernia, the stomach stays in an abnormal position, which can increase the risk of strangulation – a medical emergency where the stomach’s blood supply is restricted.
Diagnosing a hiatal hernia involves a combination of a physical examination and diagnostic tests to confirm its presence and assess its severity.
During a routine check-up, a doctor may suspect a hiatal hernia based on the patient’s symptoms. However, because the symptoms of a hiatal hernia can mimic other conditions, a physical examination alone is usually insufficient to confirm the diagnosis, making further testing necessary.
Barium Swallow X-ray: The patient drinks a contrast liquid that coats the oesophagus and stomach, making them visible on X-rays. This test helps detect if part of the stomach has moved through the diaphragm.
Chest or Abdominal X-rays: These may reveal larger hernias, especially when investigating unexplained chest or abdominal pain.
An upper endoscopy, or gastroscopy, involves passing a thin, flexible tube with a camera through the throat into the oesophagus and stomach. This procedure allows doctors to identify the presence of a hiatal hernia and detect signs of inflammation or damage caused by acid reflux. It also helps rule out other conditions with similar symptoms.
Consult our MOH-accredited specialist for an accurate diagnosis & personalised treatment plan today.
The treatment of a hiatal hernia depends on the severity of symptoms and the type of hernia.
Non-surgical treatments aim to manage symptoms and reduce discomfort without the use of invasive procedures. These are typically recommended for individuals with mild to moderate symptoms.
These medications work by neutralising stomach acid, providing temporary relief from heartburn. They do not stop acid production but can help reduce the burning sensation by making the stomach contents less acidic.
PPIs are often used for long-term management of hiatal hernia symptoms by reducing stomach acid production. However, long-term use requires medical supervision.
H2 blockers, like PPIs, reduce stomach acid production, but they act faster. They can be taken as needed to relieve symptoms or regularly to avoid acid reflux issues.
Surgery is generally reserved for patients who do not respond to non-surgical treatments or develop complications, such as a large paraesophageal hernia that can cause serious health issues.
This is a minimally invasive procedure where the upper part of the stomach is wrapped around the lower oesophagus. This reinforces the valve between the oesophagus and the stomach, helping to prevent acid reflux. It is often recommended for patients with persistent symptoms despite non-surgical management.
The stomach is returned to its original position in the abdomen, and the opening in the diaphragm (hiatus) is tightened to prevent the stomach from slipping back through. This surgery addresses the structural cause of the hernia, helping to prevent it from recurring. It can be done using traditional open surgery or laparoscopically, which involves smaller incisions and a quicker recovery.
During hernia repair surgery, the surgeon may also tighten the opening in the diaphragm where the hernia occurred. Reducing the size of this gap makes it more difficult for the stomach to push through again. This helps to prevent recurrence, particularly in individuals at higher risk.
While some factors, such as age and congenital conditions, cannot be controlled, maintaining a healthy weight, eating smaller meals and avoiding activities that increase abdominal pressure, such as heavy lifting or straining, can help reduce the risk. Proper lifting techniques and managing chronic coughing or constipation can also minimise abdominal strain and lower the likelihood of hernia development or recurrence.
MBBS (S’pore)|
M.Med (Surgery)|
MRCS (Ireland)|
FRCS (Edin)|
王健名医生
Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.
Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.
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Hiatal hernias, especially large ones, typically do not resolve on their own. Small hiatal hernias may remain asymptomatic and not need immediate treatment, but they usually persist without medical intervention. Managing symptoms through lifestyle changes and medication can help, though surgery may be required for complete resolution.
A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity, while other hernias, like inguinal or umbilical hernias, involve organs such as the intestines protruding through weak spots in the abdominal wall. The key difference lies in the affected organs and their location.
Exercise can be beneficial, but you should avoid activities that put excessive strain on the abdomen, such as heavy lifting or intense abdominal workouts. Low-impact activities like walking, cycling, and swimming are safer and can help with weight management, which may reduce symptoms.
Yes, while many hiatal hernias do not cause serious issues, some can lead to complications if left untreated. Paraesophageal hernias can cause the stomach to become trapped, cutting off its blood supply (strangulation), and requiring emergency care. Chronic acid reflux due to a hiatal hernia can also lead to oesophagitis, ulcers, or Barrett’s oesophagus, which may increase the risk of oesophageal cancer.