Hiatal Hernia Symptoms: Heartburn, Causes and When to Be Seen

What it involves

MedlinePlus explains that a hiatal hernia is a condition in which the upper part of the stomach bulges through an opening in the diaphragm, the thin muscle between the chest and abdomen. The diaphragm helps keep acid from coming up into the esophagus, so with a hiatal hernia it is easier for acid to leak upward, which is called GERD.

Who this is for

• Adults with frequent heartburn, regurgitation or chest discomfort after eating.
• Patients over 50, or with obesity or a smoking history, who are at higher risk.
• People with trouble swallowing, a dry cough or nausea that keeps returning.
• Anyone told on an imaging test that they have a hiatal hernia and unsure what it means.

What to expect

• Questions about heartburn, swallowing, weight change, medicines, smoking and alcohol
• An exam, and blood work, which the practice offers, to check for conditions such as anemia
• Advice on meals and habits, and a medicine plan when a provider thinks it appropriate
• A referral for a barium swallow or upper endoscopy, or to a gastroenterologist, when needed

Not every chest pain is heartburn

MedlinePlus says people often learn they have a hiatal hernia while being tested for GERD, heartburn, chest pain or abdominal pain. Chest pain that is crushing, spreads to the arm or jaw, or comes with sweating or shortness of breath needs a 911 call, because a heart problem can feel like reflux. The chest pain guide explains how to decide, and the heart disease risk guide explains why a checkup helps.

What it can feel like

The reflux that a hiatal hernia can allow is described by MedlinePlus as causing heartburn, problems swallowing, a dry cough, bad breath, nausea or vomiting, breathing problems and the wearing away of teeth. Many people feel a burning behind the breastbone after large meals or when lying down. The heartburn and acid reflux guide covers the symptoms in more depth, and the persistent cough guide covers coughs that linger.

Who is more likely to have one

Often the cause is unknown, and MedlinePlus says it may have to do with weakness in the surrounding muscles, an injury or a birth defect. The risk goes up with age, and hiatal hernias are common in people over 50. You are also at higher risk if you have obesity or smoke. That is why weight and smoking come up at the visit, along with the obesity and BMI guide and the quitting smoking guide. A different kind of bulge in the belly wall is covered in the hernia guide.

How it is found

According to MedlinePlus, the tests may be a chest x-ray, an x-ray with a barium swallow, or an upper endoscopy. Those are arranged by referral rather than done at the practice. A provider can start with your history and an exam and use blood work to look for anemia from slow bleeding, as the anemia guide explains. Trouble swallowing deserves its own look, described in the difficulty swallowing guide.

Treatment and daily steps

MedlinePlus says you do not need treatment if a hiatal hernia causes no symptoms or problems. If it does, lifestyle changes may help, including eating small meals, avoiding certain foods, not smoking or drinking alcohol and losing weight. A provider may recommend antacids or other medicines, and surgery is an option when these do not help. Do not stop a prescribed medicine on your own. Constant stomach acid is also covered in the peptic ulcer guide.

Signs that should not wait

Go to the ER or call 911 for sudden severe chest or belly pain, vomiting that will not stop, vomiting blood, black or bloody stools, or being unable to swallow even liquids. Make an appointment for heartburn on most days, food that sticks, weight loss without trying or symptoms that keep you up at night. Same-day visits and walk-ins are welcome, and the blood in stool guide explains why bleeding signs matter.

Sources

• MedlinePlus: Hiatal Hernia