Acid Reflux: Understanding Hiatal Hernia Symptoms

So, you’ve been experiencing some discomfort, and you’re wondering what’s going on. Well, let’s talk about hiatal hernia symptoms and how they relate to acid reflux. A hiatal hernia occurs when your stomach pushes through the opening in your diaphragm meant for your esophagus, causing a range of uncomfortable symptoms. From heartburn to chest pain and difficulty swallowing, understanding these symptoms is key to finding relief and managing your condition. So, let’s break it down and get you feeling better in no time!

Senior man have pain in chest. Acid reflux from hiatal hernia.
Senior man have pain in chest. Acid reflux from hiatal hernia.

What is a Hiatal Hernia?

A hiatal hernia occurs when a portion of the stomach pushes through the diaphragm into the chest cavity. The diaphragm is a muscle that separates the chest from the abdomen and helps in breathing. When the stomach pushes through this opening, it results in a hiatal hernia. This condition is quite common and can affect people of all ages.


A hiatal hernia is a condition where the upper part of the stomach protrudes into the chest through a weakened or enlarged opening in the diaphragm called the hiatus. This can cause discomfort and various symptoms, including acid reflux and heartburn.


The exact cause of hiatal hernias is unknown, but several factors can contribute to their development. Aging and weakened tissues can play a role, as the natural process of aging can lead to the weakening of the diaphragm. Certain lifestyle choices, such as obesity, smoking, and poor posture, can also increase the risk of developing a hiatal hernia. Additionally, factors such as pregnancy, heavy lifting, and persistent coughing can contribute to the development of this condition.

Types of Hiatal Hernia

There are three main types of hiatal hernias: sliding hiatal hernia, paraesophageal hiatal hernia, and mixed hiatal hernia.

Sliding Hiatal Hernia

A sliding hiatal hernia is the most common type, accounting for about 95% of all hiatal hernias. In this type, the gastroesophageal junction and a portion of the stomach slide into the chest cavity through the hiatus when a person is in an upright position. This type of hernia tends to worsen when the person lies down or bends over.

Paraesophageal Hiatal Hernia

Paraesophageal hiatal hernias are less common but can be more serious. In this type of hernia, a portion of the stomach pushes through the hiatus and sits beside the esophagus. Unlike the sliding hiatal hernia, the gastroesophageal junction remains in its normal position. This type of hernia can lead to complications such as strangulation or obstruction of the herniated portion of the stomach.

Mixed Hiatal Hernia

A mixed hiatal hernia is a combination of both sliding and paraesophageal hiatal hernias. It involves the sliding of the gastroesophageal junction into the chest, as well as a part of the stomach pushing through the hiatal opening beside the esophagus. This type of hernia can cause a range of symptoms and has a higher risk of complications.

Common Symptoms of Hiatal Hernia

Hiatal hernias can cause a variety of symptoms, and their severity can vary from person to person. The most common symptoms of hiatal hernia include:

Acid reflux

Acid reflux, also known as gastroesophageal reflux, is a common symptom of hiatal hernias. It occurs when stomach acid flows backward into the esophagus, causing a burning sensation in the chest known as heartburn.


Heartburn is characterized by a burning sensation or discomfort in the chest, usually occurring after eating or when lying down. This symptom is also a common indicator of acid reflux and hiatal hernias.

Chest pain

Chest pain is another symptom that may occur with a hiatal hernia. It can range from mild to severe and is often described as a dull, aching sensation or pressure in the chest.

Difficulty swallowing

Some people with hiatal hernias may experience difficulty swallowing, medically known as dysphagia. This symptom occurs when the herniated portion of the stomach puts pressure on the esophagus, making it harder for food to pass through.


Regurgitation is the backflow of stomach contents into the throat or mouth. It can be accompanied by a sour or bitter taste and is a common symptom of hiatal hernias.

Less Common Symptoms of Hiatal Hernia

In addition to the common symptoms mentioned above, hiatal hernias can also cause less common symptoms such as:

Shortness of breath

Some individuals with hiatal hernias may experience shortness of breath, especially during physical exertion or when lying down. This symptom occurs when the herniated portion of the stomach presses against the diaphragm, affecting breathing.


Unexplained fatigue or a constant feeling of tiredness can sometimes be associated with hiatal hernias. The underlying cause of this symptom is not fully understood, but it may be related to the disruption of the digestive system.


Excessive belching or burping can occur with hiatal hernias. The herniated portion of the stomach can irritate the esophagus, leading to increased air ingestion and subsequent belching.


Hiccups can be an occasional symptom of hiatal hernias. When the herniated stomach puts pressure on the diaphragm, it can cause spasms in the diaphragm muscle, resulting in hiccups.


Some individuals with hiatal hernias may experience feelings of nausea. This symptom can be triggered by acid reflux, regurgitation, or the compression of the stomach by the hernia.

Complications of Hiatal Hernia

While many hiatal hernias do not cause serious complications, there are potential risks associated with this condition. Some of the complications that can arise from a hiatal hernia include:

Gastroesophageal Reflux Disease (GERD)

Hiatal hernias can contribute to the development of gastroesophageal reflux disease (GERD). The herniation of the stomach can weaken the lower esophageal sphincter, a muscle that prevents stomach acid from flowing back into the esophagus, leading to chronic acid reflux and irritation.


In rare cases, hiatal hernias can lead to bleeding. The stomach lining may become irritated or ulcerated due to the constant backflow of stomach acid, resulting in bleeding.


Strangulation occurs when a portion of the stomach gets trapped in the hiatal hernia, and its blood supply is cut off. This is a medical emergency and requires immediate intervention.

Esophageal ulcers

The continuous exposure of the esophagus to stomach acid due to a hiatal hernia can lead to the development of ulcers in the esophageal lining. These ulcers can cause pain and discomfort and, in severe cases, may result in bleeding.

Diagnosing Hiatal Hernia

If you suspect you have a hiatal hernia, your doctor may use several methods to diagnose your condition and determine the appropriate treatment options. These diagnostic methods include:

Medical history and physical examination

Your doctor will start by asking about your medical history and symptoms. They may perform a physical examination to check for signs of a hiatal hernia, such as abdominal tenderness or a bulge near your diaphragm.

Imaging tests

Imaging tests, such as X-rays or CT scans, may be conducted to visualize the location and size of the hiatal hernia. These tests can provide detailed images that help confirm the presence of a hiatal hernia and determine the type.


An endoscopy involves the use of a thin, flexible tube with a camera (endoscope) to examine the esophagus, stomach, and upper part of the small intestine. This procedure can help diagnose a hiatal hernia and identify any associated complications.

Esophageal manometry

Esophageal manometry is a test that measures the pressure and muscle movements in the esophagus. This test can help your doctor evaluate the functioning of the lower esophageal sphincter and detect any abnormalities caused by a hiatal hernia.

Treatment Options for Hiatal Hernia

Treatment for hiatal hernias depends on the severity of the symptoms and the type of hernia. In many cases, lifestyle changes and medications can effectively manage the symptoms. However, surgery may be necessary for more severe or complicated hernias. Treatment options include:

Lifestyle changes

Making certain lifestyle modifications can help reduce symptoms associated with hiatal hernias. These changes may include maintaining a healthy weight, avoiding foods that trigger acid reflux, eating smaller, more frequent meals, avoiding lying down immediately after eating, and quitting smoking.


Medications can help relieve the symptoms of hiatal hernias. Your doctor may recommend over-the-counter antacids or medications that reduce acid production in the stomach, such as proton pump inhibitors (PPIs) or H2 blockers, to alleviate acid reflux and heartburn.


For individuals with severe or complicated hiatal hernias that do not respond to lifestyle changes or medications, surgical intervention may be necessary. The surgical procedure aims to restore the herniated stomach to its normal position and repair the weakened or enlarged opening in the diaphragm.

Preventing Hiatal Hernia Symptoms

While it may not be possible to prevent hiatal hernias entirely, certain measures can help minimize the occurrence and severity of symptoms. These preventative strategies include:

Maintain a healthy weight

Excess weight can increase the pressure on the stomach and contribute to the development or worsening of hiatal hernias. Maintaining a healthy weight through diet and exercise can help prevent symptoms.

Avoid foods that trigger acid reflux

Certain foods, such as spicy or fatty foods, citrus fruits, tomatoes, and caffeine, can trigger or worsen acid reflux symptoms. Avoiding these trigger foods can help minimize symptoms associated with hiatal hernias.

Eat smaller, more frequent meals

Instead of consuming large meals, opt for smaller, well-balanced meals throughout the day. Eating smaller portions can reduce the pressure on the stomach, making it easier to digest food and minimizing symptoms.

Avoid lying down immediately after eating

Lying down after a meal can increase the likelihood of acid reflux and heartburn. Instead, remain upright for at least two to three hours after eating to allow gravity to keep stomach acid in its proper place.

Quit smoking

Smoking can weaken the muscles that keep the stomach in place and increase the risk of developing or worsening hiatal hernias. Quitting smoking can improve the overall health of the esophagus and reduce the likelihood of symptoms.

When to Seek Medical Attention

While hiatal hernias are common and often manageable with lifestyle changes and medications, there are situations where immediate medical attention is necessary. These situations include:

Seek immediate medical help if

  • You experience severe chest pain, especially if it is radiating to your arm or jaw. This can be a sign of a heart attack, which may mimic symptoms of a hiatal hernia.
  • You have difficulty breathing or are experiencing severe shortness of breath, as this may indicate a serious complication such as hernia strangulation.
  • You notice blood in your vomit or stools, which can indicate bleeding in the gastrointestinal tract.

Make an appointment with your doctor if

  • You have persistent or worsening symptoms despite making lifestyle changes and taking over-the-counter medications.
  • You are experiencing unintended weight loss or difficulty swallowing.
  • You have a family history of hiatal hernias or other related conditions.


Hiatal hernias can cause a range of symptoms, including acid reflux, heartburn, chest pain, and difficulty swallowing. While many hiatal hernias can be managed through lifestyle changes and medications, severe or complicated cases may require surgery. By understanding the symptoms, types, and potential complications of hiatal hernias, individuals can seek appropriate medical attention and take proactive steps to reduce the impact of this condition on their overall well-being.

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