Hiatal Hernia

A hiatal hernia occurs when the top of your stomach pushes up through an opening in your diaphragm into your chest. Your diaphragm is the muscle barrier that separates your abdominal cavity from your chest cavity. A hernia is when any organ or tissue pushes through a weakness in the tissue barrier that normally contains it. Hernias are common, and hiatal hernias are among the most common types.

Hiatal hernias push through a preexisting weakness in your diaphragm — the opening where your esophagus passes through to connect to your stomach. Healthcare providers call this opening the esophageal hiatus, which is where the term, hiatal hernia, or hiatus hernia, comes from. Stress and strain can widen this opening over time. This condition usually develops slowly over many years.

What are the different hiatal hernia types?

There are two main types: sliding hiatal hernias and paraesophageal hiatal hernias. Most people have the sliding kind, which is type 1. All of the other three types are paraesophageal hernias.

• Type 1: Type 1 — also called a sliding hiatal hernia — is by far the most common type, accounting for 95% of all hiatal hernias. In this version, the part of your esophagus that connects to your stomach slides up through the widened hiatus at times and then slides back down.
• Type 2: Types 2-4 are called paraesophageal hiatal hernias. “Paraesophageal” means “beside the esophagus.” In type 2, the upper part of your stomach pushes up through the hiatus alongside your esophagus, forming a bulge next to it. This is also called a rolling hiatal hernia.
• Type 3: Type 3 is a mix of the first two types. The part of your esophagus that connects to your stomach — the gastroesophageal junction — slides up through the hiatus at times. And another part of your stomach also bulges through, alongside the gastroesophageal junction at times.
• Type 4: Type 4 is rare, but it can be more complicated. In this version, the hiatus is wide enough for two different organs to herniate through it. The hernia involves your stomach together with another abdominal organ, such as one of your intestines, your pancreas or your spleen.

How common are hiatal hernias?

Hiatal hernias are common, especially as you get older. In the U.S., they affect about 20% of the general population. They affect 50% over the age of 50, 60% over the age of 60 and 70% over the age of 70.