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: Cham, 35-44 Male (Patient) Published: April 30

I was told I had a hiatal hernia at 16, and now at 37 it is much worse. I was told back then that I was just too young for the surgery but now as nothing I do ever gives me more than a few hours relief, I feel like going to the doctor and begging him to do the surgery. I know they say they know how we feel but unless you have one you don't know what it is like to look at food and want to throw up because you know if you eat that is what will happen. I have been on every acid blocker I have ever heard of and yes, they reduce the symptoms but I am tired of hurting all the time, not getting enough sleep, and simply not being able to eat foods I like (even bland food hurts). When a glass of water sets it off, well, it is time to do something different.

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Comment from: MarknCA, Male (Patient) Published: July 14

I have just been diagnosed with a hiatal hernia and ulcer. For years I have been taking pantoprazole and ranitidine. Yet I vomit every night and just about any time I am horizontal. I can never eat a large meal (I made the mistake one time and threw up for an hour during the night covering the bedroom and bathroom.) I have pain after every meal and exhaustion and constipation. I can't eat anything acidic; juice, alcohol, grapefruit as well as chocolate, coffee, and coke. The exhaustion after meals is the worst part along with the constant washing of sheets.

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