A hernia in the stomach most commonly refers to a hiatal hernia, where part of your stomach pushes upward through an opening in your diaphragm and into your chest cavity. The diaphragm is the sheet of muscle separating your chest from your abdomen, and it has a small hole called the hiatus where your esophagus passes through to connect to your stomach. When that opening stretches or weakens, the upper portion of the stomach can slide through it. Hiatal hernias become increasingly common with age, affecting about 14% of adults under 40 but rising to 42% of people over 80.
How a Hiatal Hernia Differs From Other Hernias
Most hernias people think of involve a bulge pushing through a weak spot in the abdominal wall, like an inguinal hernia in the groin or an umbilical hernia near the belly button. A hiatal hernia is different because it happens inside the body. You can’t see or feel a lump from the outside. Instead, the stomach migrates upward through the diaphragm into the chest cavity, which disrupts the normal barrier that keeps stomach acid where it belongs.
Types of Hiatal Hernias
The most common type is a sliding hiatal hernia, where the junction between your esophagus and stomach slides upward through the hiatus. This accounts for the vast majority of cases and is usually the less serious variety. It’s called “sliding” because the stomach can move up and down, sometimes slipping back into its normal position on its own.
A paraesophageal hernia is less common but more concerning. In this type, the junction between the esophagus and stomach stays in place, but a portion of the stomach squeezes up through the hiatus and sits next to the esophagus in the chest. This creates a risk of the stomach becoming trapped or twisted. A third type combines features of both, with the junction displaced upward and part of the stomach folding alongside the esophagus.
What Causes It
Hiatal hernias develop from a combination of factors rather than a single cause. The most significant is increased pressure inside the abdomen over time. Obesity, pregnancy, chronic constipation, and conditions that cause persistent coughing (like COPD) all push upward on the diaphragm repeatedly, gradually stretching the hiatus.
Age plays a major role because the diaphragm’s muscle tone weakens over the years. The prevalence climbs steadily with each decade of life: roughly 17% of people in their 40s, 23% in their 50s, 28% in their 60s, and 31% in their 70s. Women are affected more often, likely because of the abdominal pressure changes during pregnancy. Some people are also born with a naturally larger hiatus, which makes them more susceptible.
Symptoms to Recognize
Many people with small hiatal hernias never know they have one. The hernia itself doesn’t always cause problems. When symptoms do appear, they’re almost always related to acid reflux, because the displaced stomach allows acid to escape into the esophagus more easily.
The most common symptoms include:
- Heartburn: a burning sensation in your chest, especially after eating
- Regurgitation: food, gas, or acid rising back into your throat
- Difficulty swallowing or a feeling of a lump in your throat
- Chest pain that feels like a heart problem but isn’t
- Hoarseness or sore throat from acid irritating the vocal cords
The chest pain from a hiatal hernia can be alarming because it mimics the feeling of angina or a heart attack. If you’re experiencing recurring chest pain and haven’t been evaluated, it’s worth getting checked out to rule out cardiac causes first.
How It’s Diagnosed
Hiatal hernias are often discovered incidentally during tests for other problems. Three main tools help confirm the diagnosis. A barium swallow involves drinking a chalky liquid and then having X-rays taken as it travels down. Doctors look for the stomach extending more than 2 centimeters above the diaphragm on the images.
An upper endoscopy uses a thin, flexible camera threaded down through your mouth to visually inspect the area where the esophagus meets the stomach. The doctor can see how far the stomach has migrated and assess whether the valve between the esophagus and stomach is functioning normally. A pressure test called manometry can also measure the gap between the diaphragm and the lower esophageal valve to confirm the hernia’s size.
Managing Symptoms Without Surgery
For most people with a hiatal hernia, the goal is controlling acid reflux rather than fixing the hernia itself. Lifestyle changes make a real difference. Eating smaller meals reduces the volume of acid your stomach produces at once. Avoiding food for two to three hours before lying down gives your stomach time to empty. Losing weight, if relevant, reduces the upward pressure on the diaphragm that worsens the hernia over time.
Sleep positioning matters more than most people realize. Regular pillows only elevate your head, which isn’t enough to prevent acid from traveling up the esophagus. A wedge pillow set at a 30 to 45 degree angle elevates your entire torso, making it physically harder for acid to escape your stomach. The broad end goes flat against your headboard, and the thinnest part should hit between your hips and mid-back so your head, shoulders, and upper body are all supported. Most effective wedge pillows raise the head between 6 and 12 inches.
When Surgery Becomes an Option
Surgery is typically reserved for people whose reflux doesn’t respond to other measures, or for paraesophageal hernias that carry a risk of the stomach becoming trapped. The most common procedure wraps the upper part of the stomach around the lower esophagus to reinforce the valve and prevent acid from escaping. It’s usually done laparoscopically through small incisions.
The results are generally strong. Studies report successful symptom relief in 80% to 95% of patients over five years or more. The average hospital stay is about two days, and patients typically eat a semi-liquid diet for two weeks afterward. About 14% of patients eventually need a second operation, most often within the first five years, either for reflux returning or for persistent difficulty swallowing.
Rare but Serious Complications
Large paraesophageal hernias carry a small but real risk of the stomach becoming trapped (incarcerated) in the chest. In rare cases, the trapped portion loses its blood supply and the tissue begins to die. Warning signs include sudden, severe upper abdominal or chest pain, vomiting, difficulty belching, and shortness of breath. These symptoms, particularly after a large meal, require emergency evaluation. A trapped, twisted stomach can lead to perforation if not treated quickly.