Hiatal Hernia - Symptoms

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What are the signs and symptoms of a hiatal hernia?

By itself, a hiatal hernia causes no symptoms, and most are found incidentally when a person has a chest X-ray or abdominal X-rays (including upper GI series, and CT scans, where the patient swallows barium or another contrast material). It also is found incidentally during gastrointestinal endoscopy of the esophagus, stomach and duodenum (EGD).

Most often if symptoms occur, they are due to gastroesophageal reflux disease (GERD) where the digestive juice containing acid from the stomach moves up into the esophagus.

The stomach is a mixing bowl that allows food and digestive juices to mix together to begin the digestive process. The stomach has a protective lining that prevents acid from eating away at the stomach muscle and causing inflammation. Unfortunately, the esophagus does not have a similar protective lining. Instead it relies on the lower esophageal sphincter (LES) located at the GE junction and the muscle of the diaphragm surrounding the esophagus to act as a valve to prevent acid from refluxing from the stomach into the esophagus. In addition to the LES, the normal location of the GE junction within the abdominal cavity is important in keeping acid where it belongs. There is increased pressure within the abdominal cavity compared to the chest cavity, particularly during inspiration, and the combination of pressure exerted within the lowermost esophagus from the LES, the diaphragm and the abdominal cavity creates a zone of higher pressure that keeps stomach acid in place.

In the situation of a sliding hiatal hernia, the GE junction moves above the diaphragm and into the chest, and the higher pressure zone is lost. Acid is allowed to reflux back into the esophagus causing inflammation of the lining of the esophagus and the symptoms of GERD.

These symptoms may include the following:

  • heartburn: chest pain or burning,
  • nausea, vomiting or retching (dry heaves)
  • burping
  • waterbrash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid

Symptoms usually are worse after meals. These symptoms may be made worse when lying flat and may resolve with sitting up or walking.

In some patients, reflux into the lower esophagus sets off nervous reflexes that can cause a cough or even spasm of the small airways within the lungs (asthma). A few patients may reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing coughing spasms, asthma, or repeated infections of the lung including pneumonia and bronchitis. This may occur in individuals of all ages, from infants to the elderly.

Most paraesophageal hiatal hernias have no symptoms of reflux because the GE junction remains below the diaphragm, but because of the way the stomach has rotated into the chest, there is the possibility of a gastric volvulus, where the stomach twists upon itself. Fortunately, paraesophageal hernias are relatively uncommon. However, volvulus is a surgical emergency and causes difficult, painful swallowing, chest pain, and vomiting.

Return to Hiatal Hernia

See what others are saying

Comment from: Robert K., 75 or over Male (Patient) Published: April 05

I had hiatal hernia surgery days ago, expect to be fine in a few more days. One thing is carbonated beverages are forbidden for a while, yet the only thing that helps my bloated feeling is burping, which I wait for until I continue eating. I thought a soda drink would help with that. I also have pain in my left shoulder; curious side effect. One other thing that might help people during recovery is chicken soup with rice, and similar things, which can be 'souped up' in a blender, and provide a good nourishing liquid meal.

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Comment from: tnt, 55-64 Male (Patient) Published: May 11

Hi to my fellow hiatal hernia sufferers. I also have GERD with a hiatal hernia. It has been going on now for 5 years, the pantoprazole and Nexium not working any more. I have tried everything except surgery. I have terrible chest, arm, back (between shoulder blades) and stomach pains. It pains at night as I try to lie down and sleep. I don't know what to eat anymore as everything I eat causes pain. It is so bad I maybe get relief at 4 to 5 am. I have been up all night at times. My life is starting to be really awful. I am looking into surgery as a last option! I hope someone with my same symptoms has better luck. I will keep you posted as to surgery results.

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