Symptoms Of A Hiatal Hernia

What is a hiatal hernia?

A hiatal hernia is a disorder referring to the abnormal protrusion of the gastroesophageal organs above the diaphragm, through the hiatus (a gap in the diaphragm), in the thoracic cavity. This exerts extra pressure in the cavity hence creating negative effects on the body.1 

Types of hiatal hernia

​​There are two main types of hiatal hernia called sliding hiatal hernia and paraesophageal hiatal hernia, both of which include the disorganisation of certain organs in the abdomen, hence causing further health issues.

Sliding hiatal hernia

A sliding hiatal hernia occurs when the gastroesophageal junction (stomach and oesophagus) slides up, towards your chest through the hiatus (opening in the diaphragm).2

Paraesophageal hernia

A paraesophageal hiatal hernia occurs when the upper portion of your stomach bulges through the hiatus into the chest encroaching into the oesophageal space.2 This is known to be more dangerous than the sliding hiatal hernia. The paraesophageal hiatal hernia is more permanent and the stomach and oesophagus stay where they need to be in position, which is different from a sliding hiatal hernia.

What are the symptoms of a hiatal hernia?

Sliding hiatal hernia and paraesophageal hiatal hernia have different symptoms and issues relating to them, both of which require immediate diagnosis as the condition can deteriorate if patients are not diagnosed early.3

Generally speaking, both types of hiatal hernias start with symptoms such as bad breath, feeling gassy, feeling breathless, burping, feeling bloated, feeling sick or actually vomiting and experiencing pain when ingesting food or finding it taxing to do so.3 

A sliding hiatal hernia can cause gastroesophageal reflux disease (GERD), which refers to the regurgitation of stomach acid (HCl) up into the oesophagus (food pipe) as a result of weakened muscle in the oesophageal sphincter.4 Gastroesophageal reflux in simple terms is referred to as acid reflux, which is a condition that can lead to heartburn and is even known to initiate angina. GERD can lead to many other health complications such as ulcerations in the digestive tract which can further lead to haemorrhages, as well as oesophagitis.2 Oesophagitis can occur due to the persistence of acid reflux, which is where the oesophageal tissue gets inflamed and may get infected.

On the other hand, patients with paraesophageal hiatal hernias usually tend not to experience gastroesophageal reflux symptoms.3 This is because the patients with paraesophageal hiatal hernias have dilated stomach as a result of the reorganisation of organs inside the abdomen due to the hernia. The stomach dilation ends up compressing the oesophagus, thus inhibiting gastric reflux (gastric obstruction), which is the reason the symptoms of sliding hiatal hernias are very much dissimilar to each other. The compression of the oesophagus can also lead to ischaemic gastric infarctions, which is caused due to the lack of circulation in the digestive tract. Moreover, the ingestion of food can lead to pain and discomfort which can be confused with a heart attack or even angina, due to its restrictive nature.3 Though the symptoms of angina and heart attack are confused with other symptoms of this disease, they can occur if conditions are chronic. Hence, the human body undergoes necrosis of certain tissues where the blood supply is cut off to a particular area and it dies.3

Overall, both sliding hiatal hernia and paraesophageal hiatal hernia can be fatal if symptoms are not managed, not known or misdiagnosed. Therefore, it is immanent that people who have even the slightest doubt need to see a doctor immediately.

What causes a hiatal hernia?

The main causes of hiatal hernia include the increase in pressure in the abdominal cavity, which can be caused due to external strain, obesity, excessive coughing or vomiting, applying extreme pressure during excretion and weight lifting. The added pressure in the abdominal cavity can cause undue distress to the organs and thus put them in a disarray.

How is a hiatal hernia diagnosed?

Hiatal hernias are diagnosed through the use of barium radiographs or procedures such as endoscopies.3 

Barium radiography involves patients swallowing a barium compound suspension. This allows the soft tissue organs in the abdomen, such as the stomach in the body, to be highlighted in the X-ray, therefore creating greater clarity in the radiographs, allowing doctors to better decipher the severity of the condition, the orientation and position of the stomach, thus helping them ascertain the situation leading to a diagnosis. CT scans can also be used to help better distinguish between the organs.

Sliding hiatal hernia can also be diagnosed with the determination of the shortened length of the oesophagus, which can be done with an endoscopy (the observation of internal organs through the insertion of a small camera into the body). Though this is usually a reliable method, it may sometimes lead to misdiagnosis with people who hereditarily have a shorter oesophagus.3 

Paraesophageal hiatal hernia can sometimes present as an asymptomatic condition and is very easily misdiagnosed with pneumonia bronchogenic cysts and a few other conditions. Paraesophageal hiatal hernia can be conclusively diagnosed with upper gastrointestinal series radiography of the torso, specifically the duodenum, oesophagus and stomach. These results would need to determine a clear abnormal organisation of the organs in the abdomen as it can be hard to decipher these in radiographs.

How to treat a hiatal hernia?


Taking over-the-counter antacid medication such as Gaviscon and/or H-blockers can help reduce the impacts of the symptoms.9 Additionally, if conditions are critical, doctors can prescribe medications, such as omeprazole and lansoprazole, to help sustain extreme cases.9 


Sliding hiatal hernia can be treated through surgery; however, it is only advised in particular situations.5 Surgery reduces the impact of symptoms of reflux oesophagitis and prevents the onset of chronic ulcers and reactive submucous fibrosis (precancerous disorder). 

Fundoplication, another procedure methodised to repair sliding hiatal hernia, involves wrapping the fundus (part of the stomach) around the sphincter of the oesophagus to help reinforce it, thus alleviating reflux symptoms.6 Though this is now a standardised approach and is more effective than taking anti-reflux medication, it still has its complications, which can result in a reversal of the herniation.

On the contrary, another way to treat both types of hiatal hernias is to perform surgery using prosthetic meshes that are used alongside procedures involving the reconstruction of the oesophageal hiatus by closing the crura membrane, thus restricting the protrusion of the stomach above the diaphragm. This technique is called laparoscopic anti-reflux surgery, which is found to be more effective than fundoplication, resulting in fewer complications in the long run.7 

Furthermore, paraesophageal hiatal hernia is treated by performing surgery which involves the complete removal of the peritoneal sac (an organ in the peritoneal cavity), allowing the stomach to be pushed back into the abdominal cavity.8 This technique is more complicated than techniques required to treat sliding hiatal hernia and is not always carried out due to further complications such as secondary infections.

Permanent surgeries are only performed in critical conditions, whereas relatively lesser invasive techniques such as fundoplication are favoured, as it is more preventative. However, it depends on the extent of the herniating of the stomach. 

Lifestyle changes

Many lifestyle changes are to be made for people with hiatal hernias to sustain the disease. These changes include:

  • Losing weight, if the patient is classed as overweight, by reducing meal portions and inculcating daily exercises.9
  • Avoiding fatty foods, caffeine, alcohol and certain condiments such as ketchup and mustard.9
  • Avoiding eating meals late at night as this can cause acid reflux.
  • Raising the head of the bed by 6 inches to avoid acid reflux.9
  • Reducing the frequency of wearing belts can reduce the regurgitation of stomach acid.9

Home remedies

Home remedies that are known to help sustain this disease include:10

  • Practising yoga
  • Drinking herbal teas such as sandalwood or chamomile
  • Drinking cold milk
  • Eating coconut fruit pulp


  • The length of the oesophagus is shortened due to a lack of tension in the oesophagus, hence causing the decrease in distance between the stomach and the pharynx.
  • There is a persistence of chest infections, respiratory conditions as well as vomiting due to the development of hiatal hernias.3
  • Patients can develop iron deficiencies due to malabsorption of nutrients, which can lead to anaemia.3
  • People with hernias are prone to chronic haemorrhages and if left untreated can also cause anaemia.3
  • The orientation of the stomach can be completely rotated in extremely severe cases.3


The best way to prevent hiatal hernia is to maintain a healthy balanced diet and to avoid being overweight, if this is the case then exercise is required. Furthermore, smoking can cause an onset of the condition, so avoiding it would reduce the chances of it occurring.9 Additionally, avoiding the consumption of certain acidic food will reduce GERD.

Living with a hiatal hernia

Living with a hiatal hernia is not easy, and the challenges faced by patients can very easily go unnoticed. However, making small lifestyle changes, maintaining certain restrictions for oneself, taking necessary medication and getting required treatment can help sustain these difficulties. Though it is not easy, people can go on with this disease, especially if it is diagnosed earlier rather than later.


Both types of hernias can be fatal if left untreated;3 however, paraesophageal hiatal hernia has a higher morbidity rate than sliding hiatal hernia. Therefore, it is essential that you must seek immediate medical advice if any aforementioned symptoms are experienced.


  1. Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, et al. Guidelines for the management of hiatal hernia. Surg Endosc [Internet]. 2013 [cited 2022 Oct 28]; 27(12):4409–28.
  2. Kavic SM, Segan RD, George IM, Turner PL, Roth JS, Park A. Classification of Hiatal Hernias Using Dynamic Three-Dimensional Reconstruction. Surg Innov [Internet]. 2006 [cited 2022 Oct 28]; 13(1):49–52.
  3. Dean C, Etienne D, Carpentier B, Gielecki J, Tubbs RS, Loukas M. Hiatal hernias. Surg Radiol Anat [Internet]. 2012 [cited 2022 Oct 28]; 34(4):291–9.
  4. Klauser AG, Schindlbeck NE, Müller-Lissner SA. Symptoms in gastro-oesophageal reflux disease. The Lancet [Internet]. 1990 [cited 2022 Oct 28];
  5. Heerden JA van. Anson & McVay Surgical Anatomy. Mayo Clinic Proceedings [Internet]. 1984 [cited 2022 Oct 28]; 59(11–12):806–7.
  6. Nissen R. [A simple operation for control of reflux esophagitis]. Schweiz Med Wochenschr. 1956; 86(Suppl 20):590–2.
  7. Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc. 2007; 21(4):542–8.
  8. Patel HJ, Tan BB, Yee J, Orringer MB, Iannettoni MD. A 25-year experience with open primary transthoracic repair of paraesophageal hiatal hernia. J Thorac Cardiovasc Surg. 2004; 127(3):843–9.
  9. Hiatal Hernia. Cleveland Clinic [Internet]. [cited 2022 Oct 28].
  10. Suresh Babu S, Sheti S. A Treatise On Home Remedies /S. suresh Badu ; edited by Sunanda Sheti. Delhi: Pustak Mahal; 2007.
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Faisal Badri

BSc in Applied Medical Science, Biomedical Sciences, General, University College London

Faisal is a biomedical student with a strong interest in clinical science treatments who is currently the president of the Emirati Society.

He is an experienced Strategy intern and Scientific and Medical Writing Intern.

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