What problems does a hiatus hernia cause?

Small hiatus hernias are relatively common. Patients can sometimes be unaware of their presence. If they do cause problems it would usually be the sensation of “reflux”, as described above (read above for more information about reflux/GORD). This occurs as the diaphragm muscle no longer acts as a sphincter (or like a one way valve) to stop stomach contents rising into your chest. Because the hernia is a mechanical problem (the stomach has moved into the chest cavity), it can also cause unique problems, such as food getting stuck or caught leading to acute pain or vomiting. It may also cause a small ulcer where it rubs on the diaphragm which can cause bleeding or iron deficiency anaemia. Increasingly, evidence exists that the herniated stomach can compress the heart or lungs and cause shortness of breath.

Occasionally, the worrying and potentially life threatening problem of the stomach twisting (‘volvulus’) can occur (and often there would be intermittent symptoms leading up to this). This is because in large hiatus hernias the stomach becomes very floppy and liable to twist (usually it is held in the abdomen by ligaments but when these ligaments stretch the whole stomach can move into your chest). This is a bit like a tent which is normally held tight by ropes to tent pegs in the ground – if the ropes stretch or loosen this may allow a wind to blow and kink and potentially twist the tent.

If there is a concern this is happening, this is a strong indication for surgical repair. Other organs can also occasionally pass into the chest, such as the bowel or spleen. Another type of hiatus hernia is a para-oesophageal hernia whereby part of the stomach separately comes up as a hernia next to the oesophagus. Because it is separate it can get trapped (incarcerated) and thereby causing discomfort, pain, trouble swallowing and gangrene (from lack of blood supply).