What symptoms have you experienced with hiatal hernia?
Share your story with others:
MedicineNet appreciates your comment. Your comment may be displayed on the site and will always be published anonymously.
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,
vomiting or retching (dry
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.