If you have been told you have a hiatal hernia in Northern Virginia, or you are wondering whether one could be behind your heartburn, it helps to understand what the term actually means. A hiatal hernia is a common condition, and in many people it causes no symptoms at all. This guide explains what a hiatal hernia is, the two main types, how it relates to acid reflux, the symptoms it can cause, how it is diagnosed, and when treatment is usually considered.
This article is general education, not medical advice. Your symptoms should be evaluated by a physician who can consider your full history.
What is a hiatal hernia?
Your diaphragm is the muscle that separates your chest from your abdomen, and your esophagus passes through a small opening in it called the hiatus on its way to your stomach. A hiatal hernia happens when the upper part of the stomach pushes up through that opening into the chest. According to the National Library of Medicine, a hiatal hernia occurs when the upper part of the stomach bulges through an opening in the diaphragm. Many hiatal hernias are small, and a great many people who have one never notice it.
How common is a hiatal hernia?
Hiatal hernias are common, and they become more frequent with age. They affect roughly 1 in 5 people in the general population and are far more common in older adults. Because so many cause no symptoms, plenty of people never know they have one until it turns up during a test done for another reason. If you are dealing with a hiatal hernia in Northern Virginia, it can be reassuring to know that the condition itself is widespread and often harmless.
Types of hiatal hernia: sliding and paraesophageal
There are two main types. A sliding hiatal hernia is by far the most common. In this type, the spot where the esophagus meets the stomach slides up through the hiatus and back down, sometimes moving with breathing or position. The second type is a paraesophageal hernia, in which part of the stomach pushes up alongside the esophagus while the junction stays in place. Paraesophageal hernias are less common but get closer attention from physicians, because a larger one can occasionally lead to complications and may need more careful monitoring or treatment.
Why many hiatal hernias cause no symptoms
One of the most important things to understand is that many hiatal hernias are small and produce no symptoms whatsoever. People often live for years with a small sliding hernia and feel completely fine. When that is the case, the hernia usually does not require any treatment at all. Trouble tends to arise only when a hernia is larger or when it allows stomach acid to travel back up into the esophagus more easily.
The relationship between hiatal hernia and acid reflux
The reason a hiatal hernia matters most often comes down to its link with acid reflux. Normally the diaphragm helps keep stomach acid from rising into the esophagus. When part of the stomach slides up through the hiatus, that barrier can weaken, and it becomes easier for acid to come back up. This is why a hiatal hernia is closely associated with gastroesophageal reflux disease, or GERD. Not everyone with a hiatal hernia develops reflux, and not all reflux is caused by a hernia, but the two frequently travel together. If reflux is your main concern, you may also find it helpful to read our guide to GERD and acid reflux in Northern Virginia.
Symptoms of a hiatal hernia when they appear
When a hiatal hernia does cause symptoms, they usually overlap with the symptoms of acid reflux. Common ones include a burning feeling in the chest known as heartburn, a sour or acidic taste from regurgitation, difficulty swallowing, a chronic dry cough, bad breath, and sometimes nausea. Some people notice discomfort in the upper abdomen or chest, especially after large meals or when lying down. Because chest discomfort can also come from the heart, any new, severe, or unexplained chest pain should be treated as an emergency rather than assumed to be a hernia.
What causes a hiatal hernia?
Often the exact cause of a hiatal hernia is unknown. It can develop when the muscle tissue around the hiatus weakens or when pressure in the abdomen increases. Factors associated with a higher chance of having one include older age, carrying extra weight, and smoking. In some cases an injury or a difference present from birth plays a role. For many people, no single cause can be pinpointed, and that is normal.
How a hiatal hernia is diagnosed
A hiatal hernia is often found during tests done to look into reflux or swallowing symptoms. A physician may use an X-ray with a barium swallow, in which you drink a chalky liquid that outlines the esophagus and stomach on imaging, or an upper endoscopy, in which a thin, flexible camera is passed gently through the mouth to view the esophagus and stomach directly. Endoscopy also lets a gastroenterologist check for inflammation or other changes in the esophageal lining. You can learn more about hiatal hernia from the National Library of Medicine.
When treatment for a hiatal hernia is considered
Care is individualized, and a gastroenterologist tailors it to your situation. A hiatal hernia that causes no symptoms generally needs no treatment. When symptoms are present, they are often the symptoms of reflux, and the first steps usually focus on managing that reflux. This can include everyday measures such as adjusting meal timing and triggers, along with acid-reducing medication when appropriate. Surgery to repair a hiatal hernia is generally considered only in specific situations, such as when symptoms or complications cannot be controlled with medication, when a hernia is large, or when a paraesophageal hernia raises the risk of complications. The decision to treat, and how, is one a physician makes with you after evaluating your full picture.
Hiatal hernia care in Northern Virginia with GC of NoVA
Gastroenterology Center of Northern Virginia helps patients across Arlington, Annandale, and the surrounding communities understand conditions like a hiatal hernia and the reflux that can come with it. Our physicians can evaluate your symptoms, arrange diagnostic testing such as upper endoscopy when it is appropriate, and work with you on a plan that fits your needs. We see patients at our Arlington office, next to VHC Health, and our Annandale office, in the Woodburn Medical complex.
To schedule an evaluation, contact our Arlington office at (703) 522-7476 or our Annandale office at (703) 560-6106, or learn more at gcofnova.com.
Frequently asked questions about hiatal hernia in Northern Virginia
Is a hiatal hernia serious?
Most hiatal hernias are small and cause no symptoms, and many people never need treatment for one. Larger hernias, and the paraesophageal type, get closer attention because they can occasionally lead to complications. A gastroenterologist can tell you what your situation calls for.
What is the difference between a sliding and a paraesophageal hiatal hernia?
In a sliding hiatal hernia, the most common type, the junction where the esophagus meets the stomach slides up through the diaphragm and back. In a paraesophageal hernia, part of the stomach pushes up beside the esophagus while that junction stays in place. Paraesophageal hernias are less common and watched more closely.
Does a hiatal hernia cause acid reflux?
A hiatal hernia can make reflux more likely because it can weaken the barrier the diaphragm normally provides, making it easier for stomach acid to rise into the esophagus. Not everyone with a hernia has reflux, and not all reflux comes from a hernia, but the two are closely linked.
How is a hiatal hernia diagnosed?
A hiatal hernia is often found during testing for reflux or swallowing symptoms. A physician may use an X-ray with a barium swallow or an upper endoscopy to view the esophagus and stomach directly and check for related changes.
This article is for general education and is not medical advice. Talk with a qualified gastroenterologist about your symptoms, diagnosis, and treatment options.
