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Hiatal Hernia Symptoms - Causes and Treatment

A hiatal hernia often causes heartburn, acid reflux, and difficulty swallowing. Learn which symptoms can occur and when to seek medical advice.

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Things worth knowing about "Hiatal Hernia Symptoms"

A hiatal hernia often causes heartburn, acid reflux, and difficulty swallowing. Learn which symptoms can occur and when to seek medical advice.

What Is a Hiatal Hernia?

A hiatal hernia (also called a hiatus hernia or diaphragmatic hernia) occurs when part of the stomach or another abdominal organ pushes upward through the diaphragm into the chest cavity. The diaphragm is a large, dome-shaped muscle that separates the chest from the abdomen and plays a key role in breathing. The most common form is the sliding hiatal hernia, in which the junction between the esophagus and the stomach slides up through the esophageal opening (hiatus) into the chest.

Symptoms of a Hiatal Hernia

Symptoms can vary greatly depending on the type and size of the hernia. Many small hiatal hernias cause no symptoms at all. Larger or more complex hernias, however, can lead to a range of complaints.

Common Symptoms

Heartburn: A burning sensation behind the breastbone, often occurring after meals or when lying down.
Acid reflux: A sour or bitter taste in the mouth caused by stomach contents flowing back into the esophagus.
Difficulty swallowing (dysphagia): Problems swallowing solid or liquid foods.
Chest pain: A feeling of pressure or pain in the chest that can sometimes resemble cardiac pain.
Belching and bloating: Frequent belching, a feeling of fullness, or nausea after eating.
Chronic cough and hoarseness: Caused by stomach acid irritating the esophagus and throat.
Shortness of breath: In rare cases, a large hernia can press on the lungs and cause breathing difficulties.

Less Common Symptoms

Anemia due to small bleeds in the trapped stomach tissue
Blood in the stool (melena) in cases of mucosal injury
Irregular heartbeat in rare cases
Unintentional weight loss due to reduced appetite or swallowing problems

When to See a Doctor

Mild and occasional heartburn does not necessarily indicate a hiatal hernia. However, medical advice should be sought promptly if:

Heartburn or acid reflux occurs more than twice a week
There is difficulty or pain when swallowing
Persistent chest pain is present (to rule out a heart attack)
Blood in the stool or unexplained weight loss is noticed
Shortness of breath occurs without another clear cause

Causes and Risk Factors

A hiatal hernia can be congenital (present from birth) or develop over time. Common risk factors include:

Increased abdominal pressure: From pregnancy, straining during bowel movements, chronic coughing, or heavy lifting
Obesity: Excess body weight increases pressure on the diaphragm
Age: Tissue naturally weakens and loses elasticity over time
Injury or surgery in the abdominal or thoracic region

Diagnosis

A hiatal hernia is diagnosed using several investigative methods:

Gastroscopy (upper endoscopy): Direct visualization of the esophagus and stomach
Barium swallow X-ray: Imaging of the digestive tract using contrast medium
Computed tomography (CT scan): Detailed cross-sectional images to determine the exact position of the hernia
pH monitoring and manometry: Measurement of acid levels and pressure in the esophagus

Treatment

Treatment depends on the severity of symptoms and the type of hernia:

Conservative Treatment

Proton pump inhibitors (PPIs): Reduce stomach acid production and relieve heartburn
Antacids: Neutralize stomach acid quickly for short-term relief
Lifestyle modifications: Weight loss, eating smaller meals, elevating the head of the bed, and avoiding alcohol and tobacco

Surgical Treatment

In severe or complicated cases, surgery may be necessary. The most common procedure is laparoscopic fundoplication, in which the stomach is repositioned below the diaphragm and the lower esophageal sphincter is reinforced to prevent reflux.

References

Kahrilas P.J. - Hiatus Hernia, in: UpToDate (ed.: Talley N.J.), Wolters Kluwer, 2023
Malagelada J.R. et al. - World Gastroenterology Organisation Global Guidelines: Dysphagia (2014), World Gastroenterology Organisation
Dent J. et al. - Epidemiology of gastro-oesophageal reflux disease: a systematic review, Gut, 2005; 54(5): 710-717

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