The cause is unknown, but hiatal hernias may be the result of a weakening of the supporting tissue. Increasing age, obesity, and smoking seem to be risk factors in adults.

Children with this condition usually have it present at birth (congenital). It is usually associated with gastroesophageal reflux in infants.

Hiatal hernias are very common, especially in people over 50 years old. This condition can cause regurgitation of gastric acid from the stomach into the esophagus.

• heartburn, worse when bending over or lying down
• swallowing difficulty
• chest pain
• belching

Note: Frequently there are no symptoms.

• barium swallow X-ray
• EGD (esophagogastroduodenoscopy)
• 24 hour pH study

The goals of treatment are to relieve symptoms and prevent complications.

Medical therapy is aimed at reducing regurgitation of stomach contents into the esophagus (gastroesophageal reflux). Medications that neutralize stomach acidity, decrease acid production or strengthen the lower esophageal sphincter may be prescribed.

Other measures to reduce symptoms include:

• avoiding large or heavy meals
• never lying down or bending over immediately after a meal
• weight reduction and smoking cessation

Failure to control the symptoms by general or medical measures or the onset of complications may require surgical repair of the hernia.

• slow bleeding and iron deficiency anemia (large hernia)
• pulmonary (lung) aspiration
• strangulation of the hernia (closing off of the hernia)

Call your health care provider if symptoms indicate you may have developed a hiatal hernia.

Call your health care provider if you have a hiatal hernia and symptoms worsen or do not improve with treatment, or if new symptoms develop.

Controlling risk factors like obesity may play a preventative role.