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Originally published February 25, 2025
Last updated April 23, 2025
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Gastroesophageal reflux disease鈥檚 (GERD) main causes are a faulty lower esophageal sphincter and/or a hiatal hernia. While physicians often assume the lower esophageal sphincter is to blame, research now shows hiatal hernias cause a higher percentage of GERD.
鈥淥ver time, we鈥檝e realized that hiatal hernias account for about 70% of reflux,鈥� says John C. Lipham, MD, a gastrointestinal surgeon with the 喵咪社区 Digestive Health Institute, part of 喵咪社区.
Surgery may be performed if a hiatal hernia is causing chronic reflux. Unfortunately, even after surgical repair, hiatal hernias often recur.
Is there a better way to treat GERD, one that prevents hiatal hernias from returning? This is what Lipham and Keck Medicine researchers are studying in a clinical trial.
A hiatal hernia develops when there is a weaknesses in the diaphragm muscle separating the thoracic and abdominal cavities. This muscle can weaken so that the upper portion of the stomach ends up pushing up and eventually through a small opening in the diaphragm (the hiatus).
Patients, especially those with a large hiatal hernia, may experience acid reflux symptoms as acid and bile flow back into the esophagus. Symptoms include heartburn, regurgitation, chest or abdominal pain, and dysphagia.
If a hiatal hernia is causing chronic GERD, treating it is important because ongoing GERD can eventually cause Barrett鈥檚 esophagus, which leads to an increased risk of esophageal cancer.
Surgery can repair a hiatal hernia. 鈥淭raditionally, we suture the hole in the diaphragm closed and place mesh over the repair,鈥� Lipham says.
Unfortunately, 30%-50% of hiatal hernias redevelop even after surgical repair. 鈥淲hen surgeries fail, it鈥檚 usually due to recurrence of the hiatal hernia,鈥� Lipham says. 鈥淚n fact, 85%-95% of the time when someone develops recurrent reflux again after surgery it鈥檚 because of recurrence of the hernia.鈥�
The mesh placed over a repaired hernia does not stop the hernia from redeveloping. 鈥淭he mesh has never been shown to decrease recurrence rates,鈥� Lipham says. 鈥淒espite this, people keep trying different types of mesh 鈥� biologic mesh, synthetic mesh, porcine mesh, you name it 鈥� to see if it will somehow result in a lower recurrence rate. Unfortunately, it hasn鈥檛.鈥�
Lipham and Keck Medicine researchers are focusing their research on how to prevent hiatal hernias from returning.
In a prospective, randomized controlled , they are studying whether platelet-rich plasma can improve wound healing and resolve hernias long-term. The use of platelet-rich plasma isn鈥檛 new; it鈥檚 already a treatment in orthopedics and dermatology.
In their study taking place at Keck Medicine, Lipham and his colleagues will treat participants鈥� hiatal hernias. One group will receive a standard mesh repair, while a second group will receive mesh treated with platelet-rich plasma.
鈥淩esearch shows that the reason people develop a hiatal hernia is because they have a collagen deficiency in the connective tissue of that area,鈥� Lipham explains. 鈥淭hat deficiency allows the hole in the diaphragm to stretch out, which leads to hernias forming. But even if we sew the hole closed, the fact remains that we鈥檙e sewing deficient tissue back together. And because of the deficiency, it doesn鈥檛 heal as tightly or as well as it should. Applying the platelet-rich plasma will increase collagen deposition. This will encourage connective tissue to grow to help keep the area together, lowering the chance of a hernia recurring.鈥�
Lipham says this is the first prospective randomized controlled trial to test platelet-rich plasma in hiatal hernia repair.
Lipham hopes this research gets the medical community thinking about a new approach to treating hiatal hernias: stimulating better wound healing to prevent recurrence.
He also believes more physicians will come to realize the outsized role hiatal hernias play in GERD. 鈥淯ntil now, everyone鈥檚 put their research money on better ways to fix the lower esophageal sphincter. But at the end of the day, they all fail because of the recurrence of the hiatal hernia,鈥� he says. 鈥淭o this day, I think there are many who don鈥檛 even realize that hiatal hernias are part of the disease, and they definitely don鈥檛 realize how much of the disease hernias are responsible for.鈥�
As more providers come to understand that hernias are responsible for 70% of GERD, more funding will be spent on research targeting hernia repair and recurrence.
鈥淪o maybe platelet-rich plasma won鈥檛 be 100% of the answer, but I think it will stimulate others to look at other ways to improve wound healing to prevent recurrence of the hernia,鈥� Lipham concludes.
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