Hiatal Hernia Treatment in Delhi, India

A hiatal hernia (also spelled hiatus hernia) is a condition where part of the stomach pushes upward through the hiatus, a small opening in the diaphragm, into the chest cavity. Normally, the diaphragm helps keep the stomach in place below the chest, but when the tissues around the hiatus weaken or are under pressure, the stomach can herniate (protrude) through this opening.

This anatomical shift can interfere with the normal function of the lower oesophageal sphincter (LES), often leading to symptoms like acid reflux, chest discomfort, and difficulty swallowing. Interestingly, many people, especially those over 50, may have a hiatal hernia without even realising it. Studies suggest that around 55 % to 60% of individuals over age 50 have some form of hiatal hernia, most of which are small and asymptomatic.

Though often benign, some hiatal hernias can lead to serious complications, particularly when a large portion of the stomach or other organs herniate into the chest cavity. Understanding the types, causes, and symptoms of hiatal hernias is crucial for early detection and effective management.

The health condition is generally classified into the following distinct types based on the anatomy of the stomach and gastroesophageal junction (the place where the oesophagus connects to the stomach). 

Type I – Sliding Hiatal Hernia 

Accounting for over 90% of all hiatal hernias, sliding hiatal hernia is the most common type of hiatal hernia. In this type, the gastroesophageal junction (GEJ), along with a part of the stomach itself, moves up into the chest through an opening in the diaphragm (the muscle that separates the chest from the belly). 

Type II – Paraesophageal Hiatal Hernia

This type of hiatal hernia occurs when the GEJ remains in its normal position, but a part of the stomach pushes up through an opening in the diaphragm, next to the food pipe.Though less common than sliding hiatal hernia, paraesophageal hiatal hernia is more likely to lead to complications. 

Type III – Mixed Hiatal Hernia

A combination of types I and II, mixed hiatal hernia occurs when the GEJ moves above the diaphragm (as in Type I) and the stomach herniates next to the oesophagus (as in Type II). Type III hiatal hernias (particularly the larger ones) require surgery.

Type IV – Complex Paraesophageal Hiatal Hernia

This is the most severe form of hiatal hernia. In this type, other abdominal organs (such as the colon, spleen, or pancreas) also herniate into the chest cavity along with the stomach. It can cause serious complications and usually requires surgery.

Hiatal hernias can arise from a range of factors, often involving internal changes that aren’t immediately noticeable. In many cases, they result from a combination of physical strain, age-related weakening of tissues, or anatomical differences present from birth. The following are some of the most common causes:

Diaphragm Weakness

Some people are born with a larger-than-normal hiatus (the opening in the diaphragm where the oesophagus passes through), making it easier for the stomach to herniate. In addition to congenital defects, age-related changes can affect the strength and flexibility of the diaphragm and surrounding tissues, increasing the risk of herniation.

Increased Intra-abdominal Pressure

Chronic coughing, heavy lifting, cycles of severe vomiting, chronic constipation, and straining during bowel movements can increase pressure inside the abdomen, pushing the stomach up through the hiatus. 

Injury or Trauma

Chest or abdominal trauma from a car crash or fall can cause a hiatal hernia by increasing pressure in the abdomen or directly damaging the structures that support the diaphragm and the hiatus. 

Surgical Complications

Some hiatal hernias occur after abdominal or thoracic surgery, especially if the diaphragm is cut or manipulated and scar tissue forms or the surgical incision does not heal properly.

While hiatal hernias can develop in almost anyone, certain individuals are more likely to experience them due to specific physical or lifestyle-related factors. Here are some common risk factors that tend to increase the risk of developing a hiatal hernia:

Pregnancy

During pregnancy, the uterus expands resulting in increased intra-abdominal pressure, which can lead to the development of a hiatal hernia. In addition to physiological changes, hormonal changes in pregnancy can lead to a hiatal hernia by relaxing the diaphragm and oesophageal sphincter (either of two muscular rings at the upper and lower ends of the oesophagus). 

Smoking

Smoking can lead to a hiatal hernia in the following ways:

• It can weaken the lower oesophageal sphincter and the diaphragmatic muscles making it easier for a part of the stomach to herniate through the oesophageal hiatus
• Smoking causes chronic cough, which increases intra-abdominal pressure (leading to the stomach moving upward into the chest cavity)
• Nicotine slows gastric motility (stomach and intestine movements that aid digestion), which can increase pressure in the stomach, increasing one’s risk of developing a hiatal hernia

Obesity

Excessive body fat, especially in the abdominal area, increases the pressure inside the abdomen, pushing the stomach up through the diaphragm. Excess fat can also increase stress on the diaphragm and supporting structures, weakening them. 

Certain Exercises or Movements 

Exercises such as deadlifts, crunches, sit-ups, and squats can lead to excessive pressure building up in the abdominal cavity, pushing a part of the stomach upward through the oesophageal hiatus. 

A hiatal hernia doesn’t always cause noticeable symptoms. When symptoms do appear, they can vary depending on the type and severity of the hernia. Here are some of the typical symptoms that people with hiatal hernia experience:

Heartburn

As the hernia disrupts the normal barrier between the stomach and oesophagus, the contents of the stomach move back into the oesophagus, causing a burning sensation in the chest, usually after eating, which might worsen when lying down or bending over.

Regurgitation

The abnormal positioning of the stomach and lower oesophageal sphincter above the diaphragm makes the lower oesophageal sphincter less effective, allowing acid, food, or liquid from the stomach to regurgitate (move back up) into the oesophagus and sometimes into the throat or mouth.

Difficulty Swallowing

As the herniated stomach compresses the oesophagus, the bulge/protrusion narrows the lower oesophagus or distorts its shape, making it harder for food to pass smoothly into the stomach. This causes difficulty swallowing or dysphagia. 

Belching 

The LES normally prevents stomach contents and gas from moving back up into the oesophagus. A hiatal hernia weakens or displaces the LES, making it less effective. This allows more air or gas to escape upward, leading to frequent belching.

Diagnosing a hiatal hernia typically involves a combination of imaging tests and procedures that allow doctors to examine the oesophagus, stomach, and surrounding structures. The following are commonly used tests or methods to confirm the presence and type of a hiatal hernia:

Upper Endoscopy

Also known as oesophagogastroduodenoscopy, upper endoscopy involves passing a flexible tube with a camera down the throat to view the oesophagus, stomach, and the top part of the small intestine. It allows doctors to see the hernia and inflammation, assess mucosal damage and check if an ulcer has developed. 

Barium Swallow

The test starts with the patient swallowing a barium (a chemical element) containing liquid. As the liquid moves through the oesophagus and stomach, X-rays are taken to trace its movement. The diagnostic test helps doctors analyse anatomical details, and identify the type of hiatal hernia

Esophageal Manometry

Usually performed before anti-reflux surgery (a surgical procedure performed to treat acid reflux), an oesophageal manometry involves inserting a thin, pressure-sensitive tube through the nose into the oesophagus to measure muscle contractions and assess lower oesophageal sphincter (LES) function.

pH Monitoring

A hiatal hernia itself may not always cause symptoms, but it often leads to acid reflux. pH monitoring is used to check how frequently and for how long acid reflux occurs (a probe is placed in the oesophagus to measure acid exposure). If acid reflux occurs frequently, a hiatal hernia may have occurred.

The approach to treating a hiatal hernia depends on the type, size, and severity of symptoms. While some cases require little to no intervention, others may call for medication or even surgery. Most treatment plans begin with lifestyle adjustments aimed at reducing discomfort and preventing symptom flare-ups. Below are the most common ways hiatal hernias are managed.

Lifestyle and Dietary Modifications

Lifestyle modification is the first line of treatment for hiatal hernias. Hiatal hernia patients can manage their condition by making these simple, yet effective lifestyle changes

• Eat smaller, more frequent meals
• Avoid trigger foods such as spicy foods, fatty foods, chocolate, caffeine, onions, citrus, and carbonated drinks
• Don’t lie down immediately after eating
• Lose those extra pounds
• Avoid smoking and cut down on alcohol 

Medications

The following group of medicines may not cure a hiatal hernia, but can help manage hiatal hernia symptoms 

• Antacids: Provide quick relief by neutralizing stomach acid
• H2-receptor blockers: Reduce acid production
• Proton pump inhibitors (PPIs): Reduce production of stomach acids in the long term 

Surgery

When lifestyle modifications do not yield results, the hernia is too large, or it causes complications, surgery is performed to 

• Repair the hiatal hernia by pulling the stomach back and narrowing the hiatus with sutures
• Place a small magnetic ring around the LES to ensure it stays closed
• Strengthen the diaphragm using mesh reinforcement (for large or recurrent hernias)

While many hiatal hernias may start off with mild or no symptoms, ignoring the condition can result in serious complications that may require medical or surgical intervention.

Here are some of the common complications that can occur if the condition is left untreated. 

Gastroesophageal Reflux Disease

A hiatal hernia can weaken the lower oesophageal sphincter (LES), allowing stomach acid to flow back into the oesophagus (GERD). Untreated GERD can lead to an inflamed oesophagus or cause Barrett’s oesophagus, a precancerous condition where normal oesophageal cells are replaced with abnormal cells.

Ulceration and Bleeding

Over time, the herniated portion of the stomach may develop ulcers due to acid exposure. Some ulcers can bleed, leading to anemia. In severe cases, ulcers caused by a hiatal hernia can lead to hematemesis (vomiting blood) or melena (black, tarry stools).

Strangulation

In paraesophageal hernia, a less common, but more dangerous type of hernia, the herniated portion of the stomach can become incarcerated (trapped and unable to move back down). This can potentially lead to strangulation. When this happens, blood flow is cut off and ischemia (lack of oxygen) can occur. 

Breathing Problems 

When a part of the stomach pushes up through the hiatus, less space is available for the lungs to expand. As a result, the mechanical pressure exerted by the herniated stomach on the lungs or lower airway can cause shortness of breath.

Volvulus

Some hiatal hernias-particularly paraesophageal hernias cause a part or all of the stomach herniates into the thoracic cavity. This abnormal position gives the stomach more room to twist, increasing the risk of volvulus (twisting of the stomach).

While hiatal hernia cannot be always avoided, especially when it is caused by age-related deterioration or has a genetic component, individuals can significantly reduce their chances of developing the condition by following the below-mentioned hiatal hernia prevention tips.

Maintain a Healthy Body Fat Percentage 

Excess abdominal fat increases pressure on the stomach and diaphragm, increasing the likelihood of a part of the stomach pushing up through the hiatus. To maintain a healthy body fat percentage, one should 

• Eat a healthy, balanced diet consisting of whole grains, vegetables, fruits, and lean meats
• Exercise regularly
• Steer clear of deep fried and sugary foods 

Practice Good Posture

Poor posture can increase pressure on the abdomen, leading to a hiatal hernia. To improve their posture one should sit and stand up straight and use lumbar support when sitting for long periods. 

Avoid Tight Clothing

Clothes that fit tightly around the abdomen (typical examples include shapewear and high-waisted pants) increase intra-abdominal pressure, potentially forcing a part of the stomach upward through the oesophageal hiatus. To reduce the likelihood of a hiatal hernia occurring, individuals should wear loose, comfortable clothing, especially after meals.

Manage Constipation

Straining during bowel movements increases intra- abdominal pressure, which can lead to a hiatal hernia. To prevent constipation, one should 

• Eat high-fiber foods (vegetables, fruits, whole grains)
• Drink plenty of water
• Avoid sitting for long periods
• Do not delay bowel movements

Can a hiatal hernia cause back pain or shoulder discomfort?

While uncommon, some people experience referred pain in the back or shoulder, especially if the hernia is large or pressing on surrounding organs. It’s important to rule out other causes of such pain.

Is a hiatal hernia the same as a hernia in the abdomen or groin?

No. A hiatal hernia involves the stomach pushing through the diaphragm into the chest cavity, unlike inguinal or abdominal hernias, which occur in the abdominal wall or groin area.

Can a hiatal hernia affect your ability to breathe?

Yes. Larger hernias can press against the lungs or diaphragm, reducing lung capacity and making it harder to breathe, particularly during exertion or while lying down.

Is it safe to exercise with a hiatal hernia?

Yes, but with caution. While low-impact exercises are generally safe, activities involving intense core pressure or heavy lifting may worsen symptoms. A doctor or physiotherapist can help tailor a suitable exercise plan.

How does a hiatal hernia affect sleep, and are there sleep positions that help?

Sleeping with the upper body elevated or lying on the left side may reduce reflux-related symptoms at night. Avoiding meals before bedtime can also help.

Can hiatal hernias come and go, or do they stay permanently?

Sliding hernias can shift in and out of the chest depending on body position or abdominal pressure. These changes may cause fluctuating symptoms.

Are there any complications of hiatal hernia that are not digestive-related?

Yes. Some people may experience respiratory issues or develop anemia due to chronic blood loss from small ulcers associated with the hernia.

Can a hiatal hernia be misdiagnosed?

Yes. Its symptoms often overlap with acid reflux, gastritis, or even heart conditions, so a clear diagnosis may require imaging or endoscopic evaluation.

Does a hiatal hernia always require surgery eventually?

Not necessarily. Many cases are managed effectively through medication and lifestyle changes. Surgery is reserved for persistent symptoms or complications.

Can women develop a hiatal hernia after childbirth?

Yes. The strain from pregnancy and childbirth can increase intra-abdominal pressure, potentially contributing to the development of a hiatal hernia.

Reviewed by Dr Rajesh Kapoor, Senior Director - GI & Hepato–Pancreatico-Biliary Surgery, Bariatric Surgery / Metabolic, Liver Transplant and Biliary Sciences, Department of General Surgery and Robotics, Gastrointestinal & Hepatobiliary Oncology, Gastrointestinal Surgery, on 10 June 2026

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