Hiatal hernia seen by chance on a scan
A CT scan, chest X-ray, barium swallow or upper endoscopy done for something else may mention a small hiatal hernia (in the UK, a hiatus hernia). It means part of the stomach sits up through the opening in the diaphragm, the muscle between the chest and the belly. The NHS says it is very common over 50. (NHS)(MedlinePlus) This page covers what the finding means and how it relates to screening, not treatment.
What the report means
MedlinePlus describes a hiatal hernia as the upper part of the stomach bulging through an opening in the diaphragm. The diaphragm helps keep stomach acid from coming up into the food pipe (esophagus), so with a hernia acid can come up more easily, which is called GERD. (MedlinePlus)
The NHS says you can have a hiatus hernia without knowing and without it being a problem, and it does not normally need treatment if it is not causing problems. (NHS) MedlinePlus also says no treatment is needed if a hiatal hernia causes no symptoms or problems. (MedlinePlus)
Types a report may name
| Type | What it is | What the review says |
|---|---|---|
| Type I (sliding) | The top of the stomach and the junction with the food pipe slide up through the opening | More than 90% of hiatal hernias; often linked to reflux |
| Type II (paraesophageal) | Part of the stomach pushes up beside the food pipe, while the junction stays in place | Types II to IV matter because the stomach can twist or become blocked |
| Type III (mixed) | A mix of types I and II | Grouped with type II as paraesophageal |
| Type IV | Another organ, such as bowel or spleen, also moves into the chest | Grouped with type II as paraesophageal |
Source: (Sfara 2019) The same review notes that the size can look different from test to test: air used during endoscopy can make a hernia look bigger, and CT cannot always show its exact shape. (Sfara 2019) Most hiatal hernias are the sliding kind.
How common it is with age
- The NHS says a hiatus hernia is very common over 50, and more common if you are pregnant or overweight. (NHS)
- MedlinePlus says the risk goes up as you age, hiatal hernias are common in people over 50, and risk is higher with obesity or smoking. (MedlinePlus)
- A 2019 review names older age and being overweight as the key risk factors. (Sfara 2019)
Hiatal hernia and Barrett esophagus screening
Barrett esophagus is a change in the lining of the food pipe linked to long-term reflux. The 2019 review says sliding hernias are linked to more severe inflammation of the food pipe and to Barrett esophagus. (Sfara 2019) Guidance treats a hernia differently when deciding who is offered a screening endoscopy:
- ACG (US, 2022) suggests a single screening endoscopy for people with long-term reflux symptoms and 3 or more of: male sex, age over 50, White race, smoking, obesity, and a parent, sibling or child with Barrett esophagus or esophageal adenocarcinoma. Hiatal hernia is not on the list. (ACG 2022)
- AGA (US, 2022) says screening may be considered with at least 3 of: male, non-Hispanic White, age over 50, smoking, long-term reflux, obesity, or family history. Reflux is one factor among several, and hiatal hernia is not listed. (AGA 2022)
- NICE (UK) says not to routinely offer endoscopy to diagnose Barrett's oesophagus, but to consider it for people with reflux disease, discussing their preferences and individual risk factors, which include a previous hiatus hernia, long or frequent symptoms, previous oesophagitis, a stricture or ulcers, and male gender. (NICE CG184)
Who qualifies, the tests and the follow-up intervals are on Barrett esophagus screening.
Who it applies to
Adults told a scan or endoscopy done for another reason shows a hiatal hernia. MedlinePlus says people usually find out during tests for reflux, heartburn, chest pain or belly pain. (MedlinePlus) If you have reflux symptoms, the NHS lists heartburn, bringing up food or bitter fluid, bad breath, bloating, feeling or being sick, and difficulty or pain when swallowing. (NHS)
NHS, when to get help for a hiatus hernia: (NHS)
See a GP if:
- your symptoms do not go away after 3 weeks
- your symptoms are very bad or getting worse
Ask for an urgent GP appointment or get help from NHS 111 if you have indigestion or acid reflux and:
- you have lost weight without trying
- swallowing becomes difficult
- you're being sick (vomiting) frequently
- there's blood in your sick
- you have pain in your upper tummy
NICE says people with trouble swallowing, or people 55 and over with weight loss plus upper tummy pain, reflux or indigestion, should be referred on a suspected cancer pathway. (NICE NG12)
Routine age-based screening
A hiatal hernia on a scan does not replace the routine screenings for your age. See screenings by age and gender. The same scan may show other findings with their own pages, such as gallstones or fatty liver.
Where they differ:
- Hiatal hernia as a screening factor. NICE lists a previous hiatus hernia among individual risk factors when endoscopy is considered for reflux disease. (NICE CG184) ACG and AGA do not include it in their screening criteria. (ACG 2022)(AGA 2022)
- Whether reflux is required. ACG starts from long-term reflux symptoms plus 3 more factors. (ACG 2022) AGA counts reflux as one of the factors, so screening may be considered without it. (AGA 2022) NICE considers endoscopy only for people with reflux disease. (NICE CG184)
- Age. ACG and AGA use age over 50 as a factor. (ACG 2022)(AGA 2022) NICE uses 55 and over for the weight loss rule in its suspected cancer guidance. (NICE NG12)
Your doctor decides what your result means for you.
Questions people ask
Is a hiatal hernia on my scan serious?
Often not. The NHS says a hiatus hernia is very common over 50, you can have one without knowing, and it does not normally need treatment if it is not causing problems. MedlinePlus says the same for a hernia without symptoms. (NHS) (MedlinePlus)
Why was it found by chance?
MedlinePlus says people usually find out during tests for reflux, heartburn, chest pain or belly pain, such as a chest X-ray, a barium swallow X-ray or an upper endoscopy. A CT of the chest or belly can also show it. (MedlinePlus) (Sfara 2019)
Does a hiatal hernia mean I need Barrett esophagus screening?
Not on its own. ACG and AGA screening criteria count risk factors such as long-term reflux, male sex, age over 50, White race, smoking, obesity and family history, and do not list hiatal hernia. NICE lists a previous hiatus hernia among the risk factors to discuss when endoscopy is considered for someone with reflux disease. Your doctor decides. (ACG 2022) (AGA 2022) (NICE CG184)
Will I need another scan?
Guidance does not set a follow-up scan for a hernia that causes no symptoms. The NHS says it does not normally need treatment if it is not causing problems. (NHS)
What symptoms should I tell a doctor about?
The NHS says to see a GP if symptoms do not go away after 3 weeks or are very bad or getting worse, and to ask for an urgent appointment for reflux or indigestion with weight loss, trouble swallowing, frequent vomiting, blood in vomit or upper tummy pain. (NHS)