From the Guidelines
Hiatal hernia symptoms can range from nonexistent to severe, depending on the size and type of hernia, with common symptoms including heartburn, regurgitation of food or liquids into the mouth, difficulty swallowing, chest or abdominal pain, feeling full quickly when eating, shortness of breath, and vomiting of blood or passing of black stools in severe cases. According to the most recent study 1, hiatal hernias can be classified into four main types, which may influence the severity of symptoms. The symptoms of hiatal hernia can be attributed to the herniation of the gastric cardia, resulting in the migration of the gastroesophageal junction to be above the diaphragm, as seen in Type I sliding hiatal hernias, or the herniation of the gastric fundus, while preserving the gastroesophageal junction in a normal position, as seen in Type II paraesophageal hiatal hernias. Many people experience worsening symptoms when lying down, bending over, or after eating large meals, likely due to increased pressure on the stomach and esophagus. Acid reflux is particularly common because the hernia allows stomach acid to flow back into the esophagus, causing irritation and discomfort. Some patients may also experience chronic cough, hoarseness, or the sensation of a lump in the throat due to irritation from stomach acid. It's essential to note that small hiatal hernias often cause no symptoms at all and may be discovered incidentally during tests for other conditions. Symptoms tend to be more severe with paraesophageal hernias compared to sliding hiatal hernias. If you experience persistent symptoms, especially difficulty swallowing or chest pain, medical evaluation is recommended to rule out complications or other conditions.
The classification of hiatal hernias into four main types, as described in the study 1, is crucial in understanding the varying severity of symptoms. The study highlights the importance of considering the size and type of hernia when evaluating symptoms, which is consistent with the findings of other research in the field, such as the study on gastro-oesophageal reflux disease management 1. However, the most recent and highest-quality study 1 provides the most relevant and up-to-date information on hiatal hernia symptoms.
Key symptoms to look out for include:
- Heartburn
- Regurgitation of food or liquids into the mouth
- Difficulty swallowing
- Chest or abdominal pain
- Feeling full quickly when eating
- Shortness of breath
- Vomiting of blood or passing of black stools in severe cases
- Chronic cough
- Hoarseness
- Sensation of a lump in the throat It is crucial to seek medical attention if symptoms persist or worsen over time, as this can indicate a more severe underlying condition.
From the Research
Symptoms of Hiatal Hernia
The symptoms of a hiatal hernia can vary depending on the type and severity of the hernia. Some common symptoms include:
- Heartburn 2, 3
- Regurgitation 2, 3
- Dysphagia 2
- Nausea 2, 4, 5
- Vague epigastric pain 2
- Abdominal pain 4, 5
- Chest pain 4, 5
- Gastroesophageal reflux disease (GERD) symptoms 2, 6
Cardiac-Related Symptoms
In some cases, a hiatal hernia can cause cardiac-related symptoms, including:
- Arrhythmias, such as atrial fibrillation, supraventricular extrasystole, and ventricular tachycardia 3
- Complete heart block 4
- Cardiac arrest 3
- Electrocardiographic changes in the ST-segment and T-wave 3
Other Symptoms
Other symptoms that may occur in patients with a hiatal hernia include: