A Hiatal Hernia Was Found at Endoscopy: What Does It Mean?

When a gastroscopy report says “hiatal hernia” or “hiatus hernia”, it means that the upper part of the stomach has moved up through the opening in the diaphragm where the oesophagus passes, towards the chest.

Hiatal hernia is quite common and becomes more frequent with age. In many people it causes no symptoms at all and is noticed by chance during an endoscopy done for another reason.

How does a hiatal hernia form?

As the oesophagus passes from the chest into the abdomen it goes through an opening in the diaphragm called the hiatus, and joins the stomach there.

If the supporting structures in this region loosen or the opening widens, part of the stomach can slide upwards. Age, excess weight and conditions that raise the pressure inside the abdomen can contribute to its development.

Are there types of hiatal hernia?

• Sliding hiatal hernia The most common type. The junction between the stomach and the oesophagus, and the upper part of the stomach, slide up above the diaphragm. Most small hiatal hernias are in this group.
• Paraoesophageal hernia Less common. A part of the stomach moves up alongside the oesophagus towards the chest. Large paraoesophageal hernias in particular should be assessed differently.

Does a hiatal hernia cause reflux?

Yes, it can make reflux easier.

A hiatal hernia can disturb the antireflux mechanism between the oesophagus and the stomach and contribute to gastro-oesophageal reflux. This can lead to heartburn, a bitter or sour taste in the mouth, belching and discomfort in the chest or stomach area.

But there is an important distinction: a hiatal hernia and reflux are not the same condition. There are people with a hiatal hernia who have no reflux symptoms, just as reflux disease can develop without a hiatal hernia.

Is a hiatal hernia dangerous?

Most small sliding hiatal hernias are not dangerous. In many people they are simply an incidental endoscopy finding and need no particular treatment.

Large hernias, and paraoesophageal hernias in particular, are assessed separately because they can cause symptoms and, rarely, complications.

Is a hiatal hernia cancer?

No. A hiatal hernia is not cancer and is not something that turns into cancer.

But in some people with long-standing reflux, reflux-related changes such as oesophagitis or Barrett’s oesophagus can develop. These are assessed separately from the hiatal hernia.

Is a biopsy needed?

A biopsy is not taken from the hiatal hernia itself.

But if oesophagitis, suspected Barrett’s oesophagus or another abnormal area in the stomach or oesophagus is seen during the endoscopy, a biopsy may be taken from there. A biopsy being taken does not mean the hiatal hernia is cancer.

Is treatment needed?

Small hiatal hernias that cause no symptoms generally need no treatment.

If there are reflux symptoms, treatment is directed mainly at controlling the reflux. Losing weight where there is excess weight, avoiding large meals close to bedtime and, in suitable patients, acid-suppressing medicines can help.

Not every hiatal hernia is operated on. Surgery may come into consideration for large or complicated hernias, for those with marked mechanical symptoms, or in appropriately assessed selected patients.

When should it be assessed more carefully?

Remember

• Hiatal hernia Is a quite common condition.
• Part of the stomach Moves upwards through the opening in the diaphragm.
• Reflux Can be present alongside a hiatal hernia, but the two are not the same thing.
• A hiatal hernia Is not cancer.
• Small hernias causing no symptoms Mostly need no particular treatment.
• Not every hiatal hernia Is operated on.