Types of hiatal hernia

The abdomen and chest are separated by a sheetlike muscle called the diaphragm. The esophagus passes through an opening (the hiatus) in the diaphragm to connect to the stomach. The upper stomach bulges through this opening to create a hiatal hernia. There are 3 main types of hiatal hernia: sliding, paraesophageal, and mixed.

Sliding hiatal hernia

In a sliding hiatal hernia, part of the stomach moves through the diaphragm so that it is positioned outside of the abdomen and in the chest. The lower esophageal sphincter (LES) often moves up above its normal location in the opening of the diaphragm.

Most people with a sliding hiatal hernia have no symptoms, and it often is diagnosed when a person is being evaluated for other health concerns. However, if the LES moves above the diaphragm, it may not close well, and stomach acid and juices may back up into the esophagus (acid reflux). This results in an uncomfortable feeling of burning, warmth, heat, or pain behind the breastbone. This may occur after eating, soon after lying down, or when bending forward, and may come and go. You may also have a sour taste in your mouth. This group of symptoms is commonly known as heartburn or reflux.

See an illustration of a sliding hiatal hernia.

Paraesophageal hernia

In a paraesophageal hernia, the stomach bulges up through the opening in the diaphragm (hiatus) alongside the esophagus (upside-down stomach). The LES remains in its normal location inside the opening of the diaphragm. This type of hernia most commonly occurs when there is a large opening in the diaphragm next to the esophagus.

The stomach and, rarely, other abdominal organs (such as the intestine, spleen, and colon) may also bulge into the chest in a paraesophageal hernia.

Mixed hernia

In a mixed hiatal hernia, the LES is above the diaphragm as in a sliding hiatal hernia, and the stomach is alongside the esophagus as in a paraesophageal hiatal hernia.

See an illustration of a paraesophageal and mixed hiatal hernia.

Paraesophageal and mixed hiatal hernias often have no symptoms or only minimal symptoms. Symptoms may include vague, nonspecific abdominal complaints such as feeling full after a meal and indigestion. If not treated, the hernia can grow. This can result in twisting (volvulus) of the stomach (possibly leading to gangrene), which requires emergency surgical treatment. Because of the risk involved in emergency treatment, it generally is recommended that all people with these types of hernias undergo surgery regardless of the symptoms.¹

Citations

1. Critchlow JF (2000). Treatment of gastric volvulus and diaphragmatic hernias. In MM Wolfe, ed., Therapy of Digestive Disorders, pp. 188–194. Philadelphia: W.B. Saunders.