Hiatus hernia occurs when the top part of the stomach protrudes through the diaphragm into the chest cavity. This is a common condition and many people will experience no symptoms at all. In others, the symptoms of hiatus hernia can be severe and can mimic the symptoms of conditions that are much more serious. Interpreting the symptoms of hiatus hernia is therefore very important for an accurate diagnosis.
A hiatus hernia occurs when part of the stomach passes through the diaphragm - the thin sheet of muscle separating the abdomen from the chest cavity. This can happen in two ways:
Sliding hiatus hernia – the most common type, in which the top muscle valve of the stomach (the oesophageal sphincter) passes through the diaphragm.
Rolling hiatus hernia – sometimes referred to as a paraoesophageal hernia, in which part of the stomach bulges up through the diaphragm, but the oesophageal sphincter remains within the abdomen.
A hiatus hernia can be caused by a range of factors that increase the pressure within the abdomen, including pregnancy, obesity, bending and straining. Because of the pregnancy factor, hiatus hernia is more common in women than men. Degeneration of the diaphragm muscle with age also means that older people are more likely to show the symptoms of hiatus hernia.
Some people experience none of the usual symptoms of hiatus hernia; they are said to by asymptomatic. Others go to their doctor with two common sets of symptoms:
Acid reflux symptoms of hiatus hernia
The most common of the symptoms of hiatus hernia is heartburn caused by acid reflux. This is because the diaphragm works in conjunction with the oesophageal sphincter to keep stomach acid in the stomach. When the sphincter is displaced and no longer has this support, stomach acid can leak into the oesophagus. The symptoms of hiatus hernia that follow range from a mild discomfort or burning sensation in the chest to severe pain, an acidic taste in the mouth and nausea. These symptoms of hiatus hernia are often referred to as gastro-oesophageal reflux disease or GERD.
The acid reflux symptoms of hiatus hernia tend to occur after eating. They are made worse by bending over, lying down or any other activity that disturbs the normal upright position of the main body trunk. In some cases, the heartburn symptoms of hiatus hernia can present as a dull pain between the shoulder blades.
Having noted this, it is important to realise that that most people with acid reflux don’t have a hiatus hernia, and most people with a hiatus hernia don’t have acid reflux.
Asthma type symptoms of hiatus hernia
Some people suffer asthma-like symptoms of hiatus hernia, as refluxed acid irritates the trachea. This can appear as a persistent cough, gurgling chest sounds or wheezing. Occasionally, the hiatus hernia can interrupt the natural movement of the diaphragm, reducing the chest capacity and causing an apparent shortness of breath, adding to the perception of asthma.
Less common symptoms of hiatus hernia
There are also some very rare symptoms of hiatus hernia:
In some cases, the stomach becomes so misplaced that it presses on the vagus nerve, changing the secretion of stomach acids and enzymes. This can lead to difficulty in digesting food, especially proteins and minerals, and can lead to malnutrition and build up of toxic food by-products in the intestines.
Acid reflux symptoms of hiatus hernia can cause problems with the oesophagus, including ulcers, which may bleed and cause you to cough or vomit blood. Furthermore, the healing of these ulcers can create scar tissue, which narrows the oesophagus causing swallowing problems.
In rare cases, the symptoms of hiatus hernia can cause the oesophagus to kink in the throat, again causing swallowing problems. A hiatus hernia can also interfere with blood supply to the stomach, a condition known as a strangulated hernia.
Symptoms of hiatus hernia can also occasionally cause severe chest pain that may be mistaken for a heart attack or angina.
Most people learn to live with the symptoms of hiatus hernia by making a few small lifestyle adjustments. Most of these aim to reduce the amount of acid that is available to reflux into the oesophagus:
Eating smaller but more frequent meals puts less strain on the sphincter.
Avoiding spicy or acidic foods will help to cut down the amount of stomach acid present.
Losing weight can also be a great help as this reduces the intra-abdominal pressure pushing the stomach up through the diaphragm.
If the acid reflux persists, it can be helpful to tilt the body during sleep to make it harder for the acid to rise up. This can be achieved with extra pillows or by raising the end of the bed.
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