Hiatus hernia

Part of the stomach sliding up into the chest. Very common, usually causes reflux, and occasionally becomes an emergency.

What it is

A hiatus hernia is when part of the stomach pushes up through the diaphragm into the chest. It becomes commoner with age, and a substantial proportion of people over 50 have one.

Most cause no symptoms at all, or cause reflux, because the valve mechanism at the bottom of the oesophagus is disrupted.

Sliding hernias, much the commonest type, are managed like reflux.

Paraoesophageal hernias are less common and matter more: part of the stomach sits alongside the oesophagus and can twist, cutting off its blood supply. That is called gastric volvulus, it is a surgical emergency, and it presents with severe chest or upper abdominal pain, retching without vomiting, and inability to swallow.

Signs you might notice

Often nothing.

Heartburn, an acid taste, and regurgitation, worse lying down or bending.

Chest pain that can mimic cardiac pain, which is why new symptoms deserve a cardiac assessment first.

Feeling full quickly, bloating, and breathlessness after eating with a large hernia.

Emergency signs: severe chest or upper abdominal pain, retching without being able to vomit, and inability to swallow. That combination is a 999 matter.

How it can affect day-to-day life

In older people and those with reduced mobility, a large hernia can cause breathlessness after meals that gets attributed to the heart or lungs.

Long-term acid suppression is the usual management and, as with reflux generally, it should have a review date rather than running indefinitely.

Chest pain is the practical difficulty. It genuinely can be either, and being told repeatedly that it is the hernia is how a cardiac problem gets missed. New or exertional chest pain should always be assessed cardiologically first.

Supporting someone well

Raise the head of the bed rather than using extra pillows.

Eat smaller meals, and leave three hours before lying down.

Manage weight and avoid tight waistbands, both of which increase pressure.

Do not accept an indefinite acid-suppression prescription without review.

Treat new chest pain as cardiac until proved otherwise.

Learn the volvulus emergency signs, particularly for anybody with a known large or paraoesophageal hernia.

Ask about surgery for a large paraoesophageal hernia, since the risk of twisting is the reason to consider it.

Where to get help

A GP can diagnose and manage, usually with endoscopy if symptoms warrant it.

999 for severe chest or upper abdominal pain with retching and inability to swallow.

Same-day assessment for any new chest pain.