A hiatal hernia occurs when the top of the stomach squeezes through the diaphragm. The diaphragm is the muscular wall that separates the chest from the abdomen. The hiatus is a small opening in the diaphragm, through which the esophagus passes to connect the mouth to the stomach. This condition is extremely common. It may exist in more than 40 percent of the population. Many cases go unnoticed.

The usual cause is weakening muscles around the hiatus. Obesity and pregnancy can create pressure that weakens these muscles. Other potential causes are stooping, bending, kneeling, or a minor birth defect.

Typical symptoms are heartburn and belching. One may have a burning taste in the mouth. Sometimes spitting up food occurs when the stomach is full. This may be more common at night. There may be a sense of food being stuck on its way down. This symptom may also be a symptom of esophageal cancer and should be evaluated by your healthcare provider.

Changes in habits often relieve symptoms completely. Eat small, frequent meals. Avoid the following foods:
* fatty foods,
* beverages with caffeine such as coffee, or cola,
* alcohol,
* tomato products, or
* citrus juices.

Smokers should quit smoking. Many overweight people note relief after losing weight. Avoid lying down or bending over within 3 hours of a meal. Avoid wearing tight belts or other restrictive clothes. Elevating the head at night with a foam wedge helps prevent spitting up. Use antacids when symptoms arise. Common products include Maalox, Mylanta, and Gaviscon. Gaviscon works well because it floats on top of stomach contents.

The most common test used to diagnose this condition is the upper G.I. series. This is a fluoroscopic exam of the esophagus, stomach and small intestine using a contrast medium called barium. Another common test is done by passing a narrow and flexible tool down through the mouth. This carries a video camera and surgical tools. Your healthcare provider may recommend surgery if lifestyle changes do not work. The procedure will close the hiatus firmly around the esophagus. Hiatal hernias often cause a ring-like constriction at the base of the esophagus. An outpatient procedure dilates this ring by passage of a long tube through the mouth.

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