This is general health information only and is not a substitute for advice from your GP or healthcare professional.
1. What is a large hiatus hernia?
A hiatus hernia occurs when part of the stomach moves upward through the opening in the diaphragm where the oesophagus passes into the abdomen. A large hiatus hernia means that a significant portion of the stomach has moved into the chest. Large hernias are more likely to cause symptoms and complications than small hiatus hernias.
2. What causes a large hiatus hernia?
The exact cause is often multifactorial. Factors that can contribute include ageing and weakening of the diaphragm, increased pressure within the abdomen from obesity, chronic coughing, constipation or heavy lifting, and previous surgery. Some people are also more susceptible because of the anatomy of the diaphragm.
3. What are the symptoms of a large hiatus hernia?
Some people have no symptoms, but larger hernias can cause heartburn, acid reflux, regurgitation, chest or upper abdominal discomfort, difficulty swallowing, early fullness after eating, bloating, nausea, or shortness of breath. Symptoms may become worse after large meals or when lying down.
4. Can a large hiatus hernia cause reflux?
Yes. A large hiatus hernia can weaken the normal barrier between the stomach and oesophagus, making it easier for stomach acid and food to flow back into the oesophagus. This can lead to gastro-oesophageal reflux disease (GORD) and, over time, inflammation or damage to the oesophageal lining.
5. How is a large hiatus hernia diagnosed?
Diagnosis may involve a gastroscopy, which allows the oesophagus and stomach to be examined directly. A barium swallow or other imaging study may also be used to determine the size and position of the hernia. Additional tests such as oesophageal manometry or pH monitoring may be recommended when reflux or swallowing symptoms require further assessment.
6. How is a large hiatus hernia treated?
Treatment depends on the symptoms and complications rather than the size alone. Lifestyle measures such as eating smaller meals, avoiding lying down soon after eating, reducing foods that trigger reflux, and losing weight where appropriate may help. Acid-suppressing medicines such as proton pump inhibitors can be used when reflux symptoms are significant.
7. Does a large hiatus hernia always require surgery?
No. A large hiatus hernia does not automatically require surgery if it is causing no significant symptoms or complications. Surgery may be considered when symptoms remain troublesome despite appropriate medical treatment, when there are complications such as significant oesophagitis or bleeding, or when the hernia causes mechanical problems such as obstruction or significant respiratory symptoms.
8. What is hiatus hernia surgery?
Surgery usually involves returning the stomach to the abdomen, repairing or narrowing the opening in the diaphragm, and often performing an anti-reflux procedure such as fundoplication. The operation is commonly performed laparoscopically. The appropriate surgical technique depends on the type and anatomy of the hernia and the patient’s symptoms.
9. What complications can occur with a large hiatus hernia?
Possible complications include severe reflux and oesophagitis, oesophageal narrowing, bleeding and iron-deficiency anaemia, stomach ulceration, and difficulty swallowing. In some large or para-oesophageal hernias, the stomach can become trapped or twisted, potentially causing obstruction or loss of blood supply.
10. When should I seek urgent medical attention?
Urgent medical assessment is required if you develop severe or sudden chest or upper abdominal pain, persistent vomiting, difficulty swallowing that is rapidly worsening, vomiting blood, black stools, severe shortness of breath, or an inability to eat or drink. These symptoms may indicate bleeding, obstruction, or another serious complication requiring prompt treatment.