What is the link between obesity and a hiatal hernia?

Obesity brings a slew of medical conditions — if you are overweight or obese, I’m sure your doctor must have already told you about its associated health implications, including a hiatal hernia. 

Unlike an inguinal hernia, which is typically associated with birth defects or heavy lifting, a hiatal hernia is almost exclusively known to be linked with obesity. Why so? Let’s find out more about this type of hernia and its treatment options. 

What is a hiatal hernia? 

A hiatal hernia is when the upper part of your stomach pushes up into your chest through an opening in your diaphragm. This opening is known as the hiatus, hence the term hiatal/hiatus hernia. 

There are two main types of hiatal hernias: 

Sliding hiatal hernia 

In normal circumstances, your oesophagus passes through the hiatus and attaches to your stomach. With a sliding hiatal hernia, your stomach and lower part of your oesophagus slide up into your chest via the diaphragm. These type of hernias (or type 1) make up a vast majority of hiatal hernia cases. 

Paraesophageal hiatal hernia 

A Paraesophageal hernia —or strangulated hernia as we commonly call it— is when your stomach and oesophagus are squeezed together. This can cause your stomach to lose its blood supply. A strangulated hernia is considered more severe than a sliding hiatal hernia. 

Can a hiatal hernia cause acid reflux? 

Many patients with hiatal hernias don’t experience symptoms and for that reason don’t always need treatment. But one of the most prominent symptoms experienced is acid reflux, as well as: 

  • Heartburn 
  • Acidic or sour taste in your mouth or throat 
  • Bloating 
  • Frequent burping 
  • Chest or abdominal pain 

Typically, a hiatal hernia can also lead to gastroesophageal reflux disease (GERD), a chronic condition characterised by frequent and severe heartburn. Please seek medical attention immediately if you experience symptoms like severe chest pain, belly pain or vomiting, as those could be signs of a strangulated hernia. 

Hiatal Hernia

Why does obesity cause hiatal hernia? 

Hiatal hernias occur because of a weakened diaphragm which allows your stomach to push through into the oesophagus, but why exactly it happens is still unclear. What we do know, however, is that factors like age, injury and genetics may play a role in a weakened diaphragm. 

That being said, for a hiatal hernia to form, you need a weakened diaphragm AND increased pressure in your abdomen to push the stomach up in the first place. This increased pressure can come from many activities, including heavy lifting, straining during bowel movements, coughing and pregnancy. 

As mentioned, being overweight or obese also increases your risk of getting a hiatal hernia — this is due to the excess weight which increases intra-abdominal pressure, causing muscle failure and giving rise to a hernia. About 37% of morbidly obese patients develop a hiatal hernia. If you are overweight, over 50 and smoke, then surely your chances of experiencing one increases further. 

How is a hiatal hernia diagnosed? 

To diagnose a hiatal hernia, I usually carry out the following tests: 

Barium swallow 

You will drink a liquid solution containing barium and undergo an X-ray to allow me to see the outline of your upper digestive tract. The X-ray also lets me see if there’s any twisting of your stomach, which potentially can be very serious. 

Endoscopy 

I will insert a thin, long tube containing a light and tiny camera down your throat to have a look at your esophagus and stomach. 

Ultrasound, CT scan or MRI scan 

This is to help determine your condition. 

Can you self heal a hiatal hernia?

As mentioned, many patients with hiatal hernias do not experience symptoms and hence do not need treatment provided the hernia does not get worse or affect their quality of life. 

Treating a hiatal hernia usually involves medication, lifestyle changes or surgery. With medication, we usually aim to treat the symptoms resulting from the hernia. So in this case, I will prescribe the same medications used to treat GERD and acid reflux — antacids, proton pump inhibitors and the like. If you have severe GERD from the hernia that doesn’t respond well to medication, surgery may be needed. 

Surgery involves pulling the entire stomach back down back into your abdomen and reducing the size of the opening in your diaphragm. The surgery is usually done laparoscopically, meaning instead of a big cut across your stomach, several small incisions are made instead. 

On your end, you should also make a few lifestyle changes to help with acid reflux symptoms due to the hiatal hernia. This includes avoiding acidic food, fried food and smoking. Needless to say, if you are overweight, consider dropping the weight. 

If you struggle with losing weight, I also do weight management procedures such as bariatric surgery and the Elipse gastric balloon

References 

  1. Wilson, L. J., Ma, W., & Hirschowitz, B. I. (1999). Association of obesity with hiatal hernia and esophagitis. The American journal of gastroenterology, 94(10), 2840–2844. https://doi.org/10.1111/j.1572-0241.1999.01426.x
  2. Khan, M., & Mukherjee, A. J. (2019). Hiatal hernia and morbid obesity-‘Roux-en-Y gastric bypass’ the one step solution. Journal of surgical case reports, 2019(6), rjz189. https://doi.org/10.1093/jscr/rjz189