What is hiatal hernia?

Hiatal hernia is actually quite common in clinical practice—especially among individuals with obesity—who may experience persistent symptoms such as heartburn, acid regurgitation, gastroesophageal reflux, and food regurgitation. During upper gastrointestinal endoscopy, we often identify hiatal hernia in such patients. But what exactly is a hiatal hernia?

The esophagus passes through a small opening—the esophageal hiatus—in the diaphragm to enter the abdominal cavity. When intra-abdominal pressure increases excessively, the hiatus may widen abnormally, thereby weakening its ability to anchor and support the esophagus. As a result, part of the stomach may protrude upward into the thoracic cavity. During endoscopic examination, this manifests as a visible hernia sac; this condition is termed “hiatal hernia.”

Patients need not be overly concerned about hiatal hernia, as it is extremely common in clinical practice. If symptomatic—for example, presenting with heartburn, acid regurgitation, food regurgitation, or reflux—treatment typically involves acid-suppressing medications (e.g., proton pump inhibitors) and prokinetic agents to enhance gastrointestinal motility. Additionally, for patients with significant obesity, weight reduction through lifestyle modifications—including dietary adjustments and regular physical exercise—is strongly recommended.