A hiatal hernia is when the top part of the stomach bulges upward into the chest through an opening in the diaphragm called the hiatus. Usually, the diaphragm acts as a barrier, preventing stomach acid from entering the esophagus. But when you have a hiatal hernia, stomach acid can flow up (acid reflux) through the opening and cause symptoms such as heartburn, chest pain, and difficulty swallowing.
This article explores common and rare hiatal hernia symptoms and signs of potential complications.
Common Symptoms
Not everyone with a hiatal hernia will have symptoms—some people with small hernias may have no noticeable signs or discomfort. Others may experience common hiatal hernia symptoms related to gastroesophageal reflux disease (GERD), which is when the muscle at the bottom of your esophagus doesn’t close correctly, allowing contents such as stomach acid to enter your esophagus.
Heartburn
Heartburn feels like a burning sensation or discomfort in the chest, often after eating, lying down, or bending over. This is because a hiatal hernia leaves an opening between the esophagus and stomach, which allows stomach acid to flow up into the esophagus rather than remain in the stomach.
Regurgitation
Regurgitation is the backflow of stomach acid or food into the mouth or throat. Normally the esophageal sphincter closes tightly to prevent this from occurring.3 With a hiatal hernia, the esophageal sphincter can weaken or get pushed out of place. This allows the stomach’s contents (food and acid) to flow upward into the esophagus, throat, or mouth.
When small amounts of stomach acid or food flow up into the throat or mouth, it can cause a bitter or unpleasant taste in your mouth. The acid may have a sour odor which can result in bad breath.1
Chest Pain
Chest pain can be a symptom of a hiatal hernia, which may feel like a burning or squeezing sensation behind your breastbone or between your shoulder blades. Sometimes, the pain may be so severe that people mistakenly think they are having a heart attack.
Difficulty Swallowing
Difficulty swallowing (dysphagia) can be a symptom of a hiatal hernia. When the stomach pushes into the chest, it can put pressure on the esophagus, leading to the sensation of food stuck in the throat. Dysphagia can range from mild discomfort when swallowing to difficulty swallowing solid foods.5
Belching or Hiccuping
With a hiatal hernia, the displacement of the stomach into the chest through the hiatal opening can disrupt the normal flow of gases, leading to excessive belching or hiccuping. These symptoms often occur shortly after eating.
Rare Symptoms
There are two main types of hiatal hernia: sliding hiatal hernia and paraesophageal hernia. About 95% of all hiatal hernia cases are sliding hernias, which occur when the gastroesophageal junction (where the esophagus and stomach meet) slides in and out of the chest through the small hole in the diaphragm (called the hiatus).
A paraesophageal hernia involves the GE junction, stomach, and/or other abdominal organs (e.g., small intestine, spleen) moving into the chest. While both hiatal hernia types can cause the more common GERD-like symptoms, only paraesophagael hernias can cause rarer, more severe symptoms such as shortness of breath (dyspnea), increased heart rate, and severe chest pain.
Shortness of Breath
With a paraesophageal hiatal hernia, the stomach and other organs protruding into the chest can compress the lungs and prevent the diaphragm from fully expanding, leading to shortness of breath.9
Increased Heart Rate
When a paraesophageal hiatal hernia is large enough to compress or irritate the heart or its surrounding structures, an increased heart rate (tachycardia) can occur. Some research suggests that a large hiatal hernia may press on and stimulate the vagus nerve, leading to an increased heart rate.
