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. Excessively elevated intra-abdominal pressure can cause this diaphragmatic hiatus to widen and weaken its ability to anchor 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—hence the term “hiatal hernia.”

Patients need not be overly concerned about hiatal hernia, as it is extremely common in clinical practice. When symptomatic—e.g., 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 loss through lifestyle modifications—including dietary adjustments and regular physical exercise—is strongly recommended as adjunctive therapy.