Hiatal hernia: signs, symptoms and complications


A hiatal hernia , also known as a gastric hernia, most often affects people over the age of 50. 90% of people with gastric hernia have no symptoms. Heartburn, abdominal discomfort, sore throat, belching, and spitting up are common among those who do this. While these symptoms may get worse, they are generally not serious. In rare cases, serious complications may develop that require urgent attention.

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Frequent symptoms

Generally speaking, a minor gastric hernia is not inherently dangerous and is unlikely to cause pain or discomfort. A hiatal hernia can change the structures and mechanisms that hold food and acids in place.

The key to this problem is a structure called the lower esophageal sphincter (LES). When a hiatal hernia occurs, it can change the position of that muscular valve, allowing stomach contents to flow back into the esophagus (called reflux ).

Associated intermittent symptoms can include:

  • Acidity
  • Regurgitation
  • Belching or hiccups shortly after eating
  • Tingling sensation in the throat
  • Sour or bitter taste in the mouth
  • Bad breath

Generally speaking, this can only appear when the hernia is enlarged. If the LES weakens further, which can occur with age, the associated symptoms may progress.

People with a hiatal hernia are more likely to develop gastroesophageal reflux disease (GERD) , a chronic form of reflux that can affect quality of life. The persistence of GERD symptoms can lead to chronic cough, chest pain, asthma, and progressive damage to tooth enamel.


Generally speaking, there are two types of hiatal hernia: sliding hiatal hernia and paraesophageal hernia . Although a sliding hernia is the most common and accounts for approximately 95% of all diagnoses, a paraesophageal hernia is potentially more serious.

  • In a sliding hiatal hernia, the junction of the esophagus and stomach (called the gastroesophageal junction) will protrude through an opening in the diaphragm called the hiatus hiatus. This is the space through which the esophagus passes. This is called "sliding" because the abdominal hernia can slide in and out of the chest when swallowed.
  • With a paraesophageal hernia, the abdomen bulges out . Although many paraesophageal hernias are the progression of a sliding hernia, others can occur suddenly if there is structural weakness in the diaphragm.

Unlike a sliding hernia, a paraesophageal hernia does not go in and out of a pause very quickly. Rather, over time, it can gradually increase in size and penetrate the chest cavity. It is in this last stage that complications can become serious and, in rare cases, be life-threatening.

Complications can include compression of the esophagus, stomach obstruction, suffocation, and an extremely rare condition known as an intrathoracic stomach.

Compression of the esophagus

Compression of the esophagus can occur when the hernia presses against the wall of the esophagus. When this happens, food can get stuck in the esophagus, causing chest pain after eating and difficulty swallowing ( dysphagia ).

Although compression of the esophagus is not considered a medical emergency, medications may be needed to relieve or prevent worsening of symptoms.

Closed hiatal hernia

Arrest occurs when a hernia of the stomach becomes trapped in the opening of the esophagus. In some cases, the symptoms of confinement can be chronic but minimal (mainly a feeling of pressure in the chest when food passes through the upper digestive tract). But this can cause blockage or obstruct circulation.

The conclusion itself is not a medical emergency unless a serious roadblock arises.


A volvulus is when a stomach hernia is twisted more than 180 degrees, causing a severe stomach obstruction. While it can happen with a hiatal hernia, it can happen without it, which is very rare. Symptoms can include dysphagia, chest pain after eating, belching, and vomiting.

If this problem progresses, it can cause pain and swelling in the upper abdomen, vomiting that leads to unproductive vomiting, and stomach bleeding (due to abnormally high blood pressure).

Acute symptomatic volvulus usually occurs in people over the age of 50 and is considered a medical emergency with a 30-50% risk of death.


Asphyxia is the interruption of the blood supply to the stomach due to volvulus or imprisonment. Symptoms include sudden, sharp chest pain; hot; fatigue; vomiting bloating; inability to pass gas; constipation; warmth or redness over the hernia; cardiopalmus; and bloody or tarry stools (due to gastrointestinal bleeding).

This is considered a medical emergency because the blockage can quickly damage the organ. If not treated right away, strangulation can lead to gangrene , shock, and death.

Inside the pectoral stomach

The intrathoracic stomach is a rare condition in which the stomach slides completely into the chest cavity. Not all cases cause symptoms, but the most common signs are shortness of breath (shortness of breath) and a feeling of fullness and pressure in the chest. Other symptoms can include vomiting, vomiting, dysphagia, gastrointestinal bleeding, and aspiration pneumonia (caused by coughing into the lungs).

An enlarged hiatal opening can cause other organs to move into the chest cavity, including the pancreas, liver, or colon. Surgery is the only way to correct this rare but serious complication.

When to see a doctor

The vast majority of hiatal hernias can be easily treated with over-the-counter medications, weight loss, and dietary adjustments. Hiatal hernias generally do not require medical treatment unless symptoms persist or worsen.

That said, you should see your doctor if your symptoms do not improve despite conservative treatment. In some cases, prescription drug adjustments and other measures may be required.

Discussion guide for hiatal hernia

Get our printable guide to your next doctor's appointment to help you ask the right questions.

You should seek immediate medical attention if reflux symptoms are accompanied by high fever (over 100.4 degrees), severe chest pain, rapid heart rate, unproductive vomiting, or bloody stools. These could be signs of a serious and life-threatening hernia complication.

Frequently asked questions

  • You may feel severe chest pain if you have a strangulated hiatal hernia. Heart palpitations and shortness of breath are also common. Other sensations may include nausea, trouble swallowing, and bloating. These are signs of a medical emergency; If you experience these symptoms, you should seek immediate medical attention.

  • Hiatal hernias don't flare up. This is a structural problem. But symptoms can get worse if you eat foods that cause gastroesophageal reflux (GERD) , eat large meals, lie down after meals, and are stressed.

  • If you have a hiatal hernia, avoid oily, fatty, highly acidic, or processed foods. Also avoid citrus fruits like oranges or limes, which can cause irritation.

  • No, only a trained healthcare professional can perform hiatal hernia surgery. Fortunately, most people with a hiatal hernia can control their symptoms with over-the-counter medications, diet changes, and weight loss. Surgery is generally not required unless symptoms persist or worsen.

  • A hiatal hernia can cause heartburn and abdominal discomfort. However, up to 90% of people with a hiatal hernia have no symptoms. Emergency care is rarely required.

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