Hiatus hernia
Board exam relevance: in 2 of 105 exam reports · rank 142- Synonyms
- hiatal hernia, diaphragmatic hernia, sliding hernia, para-oesophageal hernia, upside-down stomach
- Specialty
- Internal medicine · Gastroenterology
- Images
- X-ray 2 · Endoscopy 1 · CT 1
- Last updated
- 10/2026 · Dr. Pascal Bafteh
Contents
Images (4)
X-ray
X-ray
Endoscopy
CTDefinition
A hiatus hernia is a protrusion of the stomach through the esophageal hiatus of the diaphragm into the chest. Most hiatus hernias cause no symptoms; increased acid reflux may, however, lead to symptoms of gastro-esophageal reflux disease.
Classification
- Sliding hiatus hernia (most common form): the esophagogastric junction and part of the stomach lie above the diaphragm.
- Para-esophageal hernia: the esophagogastric junction is in the normal position, but part of the stomach lies alongside the esophagus in the diaphragmatic hiatus.
- Mixed forms and hernias involving other organs: less common; hiatus hernias can have both sliding and para-esophageal components or contain other organs.
Occurrence & epidemiology
A sliding hiatus hernia is a common incidental finding on imaging. Up to about 94 % of people with gastro-esophageal reflux disease have some degree of hiatus hernia, and up to about 67 % of people with hiatus hernia have reflux disease; the relationship between hernia and symptoms is therefore unclear.
Aetiopathogenesis
The cause is usually unknown. Acquired stretching of the fascial attachments between the esophagus and diaphragm at the hiatus – the opening through which the esophagus passes the diaphragm – is thought to be responsible. An incompetent junction favours gastro-esophageal reflux; protective factors include the action of the diaphragm and the angle between the esophagus and cardia.
Clinical features
- Sliding hernia: usually asymptomatic; chest pain and other reflux symptoms such as heartburn may occur.
- Para-esophageal hernia: also usually asymptomatic but, unlike a sliding hernia, can become incarcerated and strangulated.
- Bleeding: rare with either type, occult or massive.
Diagnosis
- Barium swallow: the preferred test; the axial length of the hernia can be measured.
- Esophagogastroduodenoscopy: also shows the hernia but is less sensitive than barium swallow; it also assesses reflux esophagitis and Barrett's esophagus.
- High-resolution manometry: complementary, to increase the sensitivity of barium swallow or endoscopy.
- Incidental finding: hiatus hernias are often discovered on chest X-ray or chest or abdominal CT.
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Further reading (open access)
Cross-references
More topics: Gastroenterology
Note: Learning content for medical education – not a treatment recommendation and no substitute for diagnosis or treatment decisions in individual cases. Treatment and management are deliberately not covered on this page.