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Hiatal Hernia
Dr. Sulaiman Bin Yusof
MbChB (Sheffield)
M.Med (Surg)
FRCSEd (Gen Surg)
蘇萊曼·尤索夫博士
A hiatal hernia occurs when part of the stomach pushes up through an opening in the diaphragm into the chest cavity.
The diaphragm is a muscle that separates the abdomen from the chest, and it normally keeps the stomach below it. This condition can cause discomfort and digestive issues, such as acid reflux or heartburn, and is more common in adults over 50.
Symptoms of Hiatal Hernia
Hiatal hernias cause a variety of symptoms due to the displacement of the stomach into the chest cavity, affecting how the digestive system functions:
Heartburn: When the stomach pushes through the diaphragm, it weakens the barrier that normally prevents stomach acid from entering the oesophagus. Heartburn occurs when stomach acid flows back into the oesophagus, a condition known as acid reflux.
Difficulty Swallowing: The hernia can put pressure on the oesophagus or cause it to become compressed, making it difficult for food to pass smoothly from the throat to the stomach.
Chest Pain or Discomfort: The stomach’s abnormal positioning can press against surrounding organs, leading to discomfort or pain, especially after meals when the stomach is full.
Belching or Bloating: The disruption in stomach positioning may cause food and gas to become trapped, resulting in excess gas build-up. This can lead to frequent burping, a sense of fullness, and bloating, particularly after eating.
Causes of Hiatal Hernia
Hiatal hernias occur when the diaphragm muscles surrounding the opening weaken, allowing the stomach to move upwards into the chest. Common contributing factors include:
Ageing
Muscle tissues throughout the body, including the diaphragm, weaken with age, making it easier for the stomach to push through the diaphragm.
Increased Abdominal Pressure
Activities like heavy lifting, chronic coughing, or straining (e.g., during bowel movements) increase pressure in the abdomen, potentially pushing the stomach through the diaphragm opening.
Obesity
Excess weight around the abdomen puts additional pressure on the stomach and diaphragm, increasing the likelihood of the stomach slipping into the chest cavity.
Genetic Predisposition
Some people may inherit weaker diaphragm muscles or anatomical differences that increase the likelihood of hernias, implying that family history is a significant factor in the development of this condition.
Diagnosis of Hiatal Hernia
Diagnosing a hiatal hernia involves several steps to accurately confirm its presence and determine the most appropriate treatment plan.
Physical Examination
The doctor will enquire about symptoms such as heartburn, chest pain, or swallowing difficulties. They may assess for acid reflux, especially after meals, to determine if a hernia is present. However, because these symptoms can resemble those of other conditions, a physical examination alone is often not enough to confirm the diagnosis, and further testing is usually required.
Imaging Tests
X-rays: These are used to visualise the position of the stomach and diaphragm, helping to identify if the stomach has moved up through the diaphragm.
Barium Swallow Test: In this procedure, the patient drinks a contrast liquid (barium) that coats the digestive tract. This makes the oesophagus and stomach visible on X-ray images, highlighting any abnormal movement or structural changes.
Endoscopy
Endoscopy, or gastroscopy, involves inserting a thin, flexible tube with a small camera down the throat to directly observe the oesophagus and stomach. This procedure is useful for identifying a hiatal hernia, assessing the severity of the condition, and detecting signs of inflammation or damage from acid reflux. It can also help rule out other conditions with similar symptoms and detect structural abnormalities.
Treatment Options for Hiatal Hernia
Treatment depends on the hernia’s size, symptom severity, and the patient’s overall health. Non-surgical methods may suffice for mild cases, while surgery is needed for complications or persistent symptoms.
Non-Surgical Treatment
Medication
Medications help manage symptoms by reducing stomach acid but do not treat the hernia itself. Antacids provide quick but short-term relief by neutralising acid. H2 blockers lower acid production to reduce oesophagal irritation and discomfort. Proton Pump Inhibitors (PPIs) are stronger, blocking acid production and promoting longer-lasting symptom relief.
Surgical Treatment
Laparoscopic Hernia Repair
This minimally invasive surgery involves making small incisions in the abdomen. A laparoscope (thin tube with a camera) and instruments are inserted to gently move the stomach back into position and tighten the diaphragm opening. Sometimes, a mesh is used to reinforce the area, reducing recurrence risk. Benefits include shorter recovery time, less pain, and fewer complications compared to traditional surgery.
Open Hernia Repair
This traditional surgical approach is usually recommended for larger or more complicated hernias. During the procedure, the surgeon makes a larger incision in the abdomen, allowing direct access to the hernia. The stomach is moved back to its proper position below the diaphragm, and the diaphragm opening is tightened. A mesh may be placed to reinforce the area and prevent future hernias. Recovery is typically longer than laparoscopic repair.
Preventing Hiatal Hernias
Preventing a hiatal hernia focuses on reducing pressure in the abdomen. Avoid heavy lifting and activities that require straining. Maintaining a healthy weight reduces abdominal pressure, lowering the risk of hernias.
Eating smaller, more frequent meals can prevent excess stomach pressure, which may help reduce symptoms. Avoid lying down immediately after eating to lower the chances of acid reflux, allowing time for proper digestion.
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Dr. Sulaiman Bin Yusof
MbChB (Sheffield)
M.Med (Surgery)
FRCSEd (General Surgery)
蘇萊曼·尤索夫博士
Dr. Sulaiman Bin Yusof is a Senior Consultant colorectal and general surgeon in Singapore with over 15 years of specialist experience across public and private practice. Trained in the United Kingdom and awarded a Ministry of Health Fellowship to the Peter MacCallum Cancer Centre in Melbourne, he has built his practice around complex colorectal surgery, with robotic-assisted technique as his primary surgical platform for colectomy and anterior resection.
Patients consult Dr. Sulaiman for his depth of experience in colorectal cancer and perianal conditions, as well as for consultations that are thorough, unhurried, and focused on giving patients a clear understanding of their options.
Credentials & Fellowship Training
Dr. Sulaiman holds an MBChB from the University of Sheffield, a Master of Medicine in Surgery (M.Med), and a Fellowship of the Royal Colleges of Surgeons of Edinburgh in General Surgery (FRCSEd). He completed a Ministry of Health Fellowship at the Peter MacCallum Cancer Centre in Melbourne, one of the world’s foremost oncology institutions, serves as a Visiting Consultant at Changi General Hospital and has contributed eight peer-reviewed publications to medical literature.
Former Director of Endoscopy, Changi General Hospital
Dr. Sulaiman served as Director of Endoscopy at Changi General Hospital, overseeing one of Singapore’s busiest endoscopy units, and brings that public-sector depth of experience to his private practice. In this role, he led a high-volume diagnostic endoscopy service encompassing colonoscopy and gastroscopy across a broad and diverse patient population.
Academic Appointments & Teaching Awards
Dr. Sulaiman holds concurrent Adjunct Associate Professor appointments at the NUS Yong Loo Lin School of Medicine, Lee Kong Chian School of Medicine, and Duke-NUS Medical School. He has been recognised on the Dean’s Honour Roll for Teaching and received the Singapore Health Quality Service Star Award 2023, reflecting his contribution to both surgical education and clinical care.
Contact Dr Sulaiman: Colorectal and General Surgeon in Singapore
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Frequently Asked Questions
How serious is a hiatal hernia?
Most hiatal hernias are not life-threatening and often cause no symptoms. However, if left untreated, larger hernias can lead to complications, such as ulcers or strangulation, requiring prompt medical attention.
Can a hiatal hernia cause breathing difficulties?
Yes, a large hiatal hernia can push against the diaphragm, which may restrict normal lung expansion. This pressure can make it difficult to breathe, especially after eating a large meal or during physical exertion, as the stomach’s abnormal positioning further compresses the diaphragm and surrounding structures.
Will a hiatal hernia come back after surgery?
Recurrence is possible but less likely if the surgical repair includes reinforcement, such as mesh placement to strengthen the diaphragm. However, following post-surgery care, such as avoiding heavy lifting and maintaining a healthy weight, is necessary to minimise the risk of recurrence and ensure the long-term effectiveness of the repair.