What is a hiatal hernia?
A hiatal hernia happens when part of your stomach moves up through an opening in your diaphragm and into your chest.
Your digestive system begins at your mouth and carries food through your esophagus, which passes through a small opening in your diaphragm—called the esophageal hiatus—before reaching your stomach. Normally, this opening fits closely around the esophagus and helps prevent acid reflux, but with a hiatal hernia, the stomach pushes through this opening.
A hiatal hernia makes it harder for your body to keep stomach acid where it belongs, leading to symptoms like heartburn, regurgitation and trouble swallowing. As the hernia grows, you may experience chest pain, early fullness, a chronic cough or shortness of breath.
Unlike other hernias, hiatal hernias cannot be seen or felt from the outside. If symptoms don’t improve or your doctor needs a closer look, imaging tests or an endoscopy may help confirm the diagnosis.
Hiatal hernia symptoms
A hiatal hernia is the most common cause of gastroesophageal reflux disease (GERD). Typical symptoms of a hiatial hernia include:
- Heartburn or acid reflux
- Indigestion (dyspepsia)
- Regurgitation (food coming back up)
- Swallowing problems (dysphagia)
Symptoms from a paraesophageal hernia include:
- Chest pain or pressure
- Early fullness
- Difficulty swallowing
- Shoulder pain
- Bloating
- Asthma-like symptoms
Less common symptoms:
- Chronic cough
- Voice hoarseness
- Sinus drainage
- Shortness of breath
When to see doctor
If heartburn, regurgitation or swallowing trouble happens often or affects your sleep, eating or daily comfort, talk with your doctor. Medications and lifestyle changes can help many people feel better, but ongoing symptoms may need further evaluation.
In rare cases, larger hiatal hernias can cause strangulation (loss of blood supply) or obstruction (blocked stomach), which are emergencies and require immediate surgery.
What causes a hiatal hernia?
A hiatal hernia can form when the tissue around the diaphragm opening weakens or stretches over time. Factors that may contribute include pregnancy, obesity, trauma, chronic coughing and repeated straining.
Complications
Most hiatal hernias cause symptoms but are not dangerous. Larger paraesophageal hernias carry more risk, including:
- Barrett’s esophagus: Acid reflux can cause precancerous changes in the esophagus.
- Esophagitis: Painful burning and ulceration of the esophagus lining.
- Esophageal stricture: Scar tissue can narrow the esophagus, making swallowing difficult.
- Strangulation or obstruction: Rare but serious emergencies requiring surgery where the stomach loses blood supply or can’t empty.
