12 Symptoms of a Hiatal Hernia

A hiatal hernia is a condition where the upper portion of the stomach protrudes through the diaphragm's opening into the chest cavity. This displacement can disrupt the diaphragm's role in containing stomach acid, potentially leading to acid reflux-related side effects. While small hiatal hernias may not manifest noticeable symptoms, thus remaining undetected in many individuals, larger herniations could give rise to significant complications or more pronounced symptoms.

1. Hiatal Hernias are Great Mimics

Hiatal hernias are often referred to by medical professionals as "the great mimics" due to their symptoms being similar to a variety of disorders. Notably, both hiatal hernias and heart attacks can manifest with chest pain, shortness of breath, and nausea—symptoms that are not unique to these conditions and can be observed in other gastrointestinal issues. To accurately diagnose a hiatal hernia, physicians may utilize diagnostic tools such as X-rays or perform an endoscopy.

2. Regurgitation

Under normal conditions, the lower esophageal sphincter functions as a barrier to prevent stomach contents from refluxing into the esophagus. A hiatal hernia, however, can compromise this sphincter's effectiveness, leading to the backward flow of gastric materials into the throat. While regurgitation typically occurs without nausea, some individuals may experience these symptoms independently. Regurgitation often involves the expulsion of undigested food and mucus, and it is commonly described as having a sour or bitter taste.

3. Heartburn

Heartburn may be caused by various factors and typically presents as a chest or lower throat burning sensation, exacerbated post-meal, upon reclining or bending. While it is commonly not indicative of severe health issues, persistent heartburn can be a warning sign of a hiatal hernia. Such hernias are often asymptomatic, but frequent heartburn might suggest that the lower esophageal sphincter is compromised due to hernia enlargement.

4. Frequent Belching or Hiccuping

Belching and hiccuping are natural reflexes and typically not causes for concern. Nevertheless, persistent or excessive belching, particularly when paired with discomfort such as bloating or pain, may indicate a need for medical evaluation. Such symptoms can be associated with more serious conditions like a significant hiatal hernia, which can also lead to acid reflux, regurgitation, heartburn, a throat stinging sensation, or a bitter taste. If these symptoms are experienced frequently, it is advisable to consult a healthcare professional for proper diagnosis and treatment.

5. Acid Reflux

It is common to mistake acid reflux for regurgitation and vice versa. Acid reflux describes the ascent of stomach acid into the esophagus, whereas regurgitation is characterized by stomach contents reaching the back of the mouth. Symptoms of acid reflux often include heartburn, nausea, bloating, and coughing. Additionally, some individuals may experience dysphagia, which is difficulty swallowing. Persistent acid reflux has the potential to damage the esophageal lining, leading to constriction that may complicate or cause discomfort during swallowing.

6. Dysphagia

Individuals suffering from dysphagia might experience additional, less common complications. Severe cases of dysphagia can result in an inability to swallow, which can lead to excessive drooling due to impeded saliva management. Prolonged dysphagia may also contribute to significant weight loss. To mitigate these effects, patients may find it beneficial to consume finely chopped foods or adapt their diet to exclude items that pose swallowing difficulties. It is crucial to recognize that persistent dysphagia, coupled with weight loss, could indicate underlying conditions such as esophageal stricture or cancer. Hence, these symptoms warrant immediate medical assessment and intervention.

7. Gastroesophageal Reflux Disease

Individuals with hiatal hernias have an increased risk of developing gastroesophageal reflux disease (GERD), a condition characterized by frequent acid reflux. GERD commonly presents with mild episodes occurring twice a week, but can also include severe, less frequent episodes. Persistent acid reflux can lead to the irritation of the esophagus, causing symptoms such as difficulty swallowing, chronic cough, laryngitis, and chest pain. Those with asthma may experience an exacerbation of their symptoms. Long-term effects of GERD include potential damage to the esophageal lining and an increased risk of Barrett's esophagus, a pre-cancerous condition, with a higher incidence reported in men.

8. Sliding Hiatal Hernia

Hiatal hernias are categorized into two main types based on their size and complexity. The more common variety, known as a sliding hiatal hernia, involves the upward displacement of both the gastroesophageal junction and a portion of the stomach into the thoracic cavity. These hernias are characterized by their dynamic nature, typically moving back and forth rather than remaining stationary. Sliding hiatal hernias tend to be smaller and often present minimal symptoms, which may include heartburn, indigestion, regurgitation, and nausea. In some cases, individuals may not experience any symptoms at all. It is essential for medical professionals to correctly identify and assess the type and severity of a hiatal hernia to determine the appropriate management and treatment.

9. Paraesophageal Hiatal Hernia

The paraesophageal hernia constitutes a less frequent yet far more hazardous form of severe hiatal hernia compared to its sliding counterpart. In this condition, the stomach ascends through the hiatus, remaining fixed in the chest cavity, potentially causing obstruction of food in the esophagus or torsion of the esophagus, which may result in compromised blood supply. Patients typically experience symptoms associated with hiatal hernias like acid reflux and swallowing difficulties (dysphagia), alongside more acute symptoms, including intense chest pain and abdominal distention. In advanced cases, paraesophageal hernias may progress to an incarcerated state. Remarkably, some individuals with paraesophageal hernias may remain asymptomatic.

10. Incarcerated Hernia

While a gastroesophageal hernia presents significant health risks, an incarcerated hernia represents an urgent medical condition demanding immediate intervention. This type of hernia exhibits all the hallmarks of a paraesophageal hiatal hernia with the additional complication of impaired blood flow. Symptoms begin with difficulties in belching and swallowing, but without prompt treatment, can escalate to more serious issues such as persistent vomiting, the presence of blood in stool or vomit, and, in severe cases, gastric perforation. If gastric perforation occurs, the patient may experience intense stomach pain, fever, nausea, and dizziness, indicative of a critical health occurrence requiring urgent medical attention.

11. Feeling Full Quickly After Eating

A lesser-known symptom of hiatal hernia is early satiety, which is the feeling of fullness shortly after beginning a meal. This arises as the protruding stomach segment takes up space within the chest cavity and diminishes the stomach's capacity to hold food. Consequently, affected individuals may experience a limited food intake, leading to possible inadvertent weight loss and could be misdiagnosed as other gastrointestinal disorders. Prompt consultation with a healthcare professional is critical for those with this symptom to explore dietary modifications and potential treatment options that can alleviate the discomfort.

12. Coughing, Hoarseness, or Sore Throat

A hiatal hernia-associated acid reflux can extend beyond digestive discomfort, potentially impacting the respiratory system and throat. Symptoms such as coughing, hoarseness, and soreness in the throat, often pronounced in the morning or postprandially, can be misinterpreted as respiratory infections or allergies. Effective management through diet, medication, or possibly surgery can significantly mitigate these symptoms, enhancing patients' well-being. Healthcare professionals may recommend surgical intervention based on symptom severity. Additional indicators of a hernia, including heartburn, dysphagia, and regurgitation, warrant medical advice. Should you experience these signs, it is prudent to consult with a healthcare provider for a thorough evaluation.