A hiatus hernia occurs when the upper part of the stomach moves into the thoracic cavity (chest) through an enlarged esophageal hiatus (opening) in the diaphragm. Hiatus hernias are common and may be seen in up to 60% of the population over 50 years old. Although often asymptomatic, sufferers complain of chest pain or heartburn with esophageal reflux, aggravated by alcohol, smoking, coffee and highly acidic foods. Discomfort is worse laying down after eating and the diagnosis is often made by special X-Rays (barium swallow).

Chest pain from hiatal hernia and/or esophageal spasms may be extremely difficult to distinguish from chest pain of cardiac origin. The symptoms of pain spreading from below the sternum (breastbone) to the neck, jaw, and arms can mimic the symptoms of coronary artery disease. If you experience any of these symptoms, it is best to immediately seek medical care to evaluate your problem.

Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.

Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply, i.e. paraesophageal hernia) or is complicated by severe GERD or esophagitis (inflammation of the esophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.