Hiatal Hernia

Symptoms

A sliding hiatal hernia generally has no symptoms.

If symptoms are present, they are usually caused by acid reflux, the flow of stomach acid into the esophagus, which may be the result of a weakened lower esophageal sphincter (LES). Symptoms of reflux include:

• An uncomfortable feeling of burning, warmth, heat, or pain behind the breastbone. It may occur after eating, soon after lying down, or when bending forward. This group of symptoms is commonly known as heartburn.
• A sour or bitter taste in the mouth. The backflow of stomach acid and juices into the esophagus (known as acid reflux) may be severe enough to cause this taste in your mouth. This often occurs along with the symptoms of heartburn, but in some cases it may be your only symptom.

Other symptoms may include:

• Fullness in the upper abdomen after a meal.
• Difficulty swallowing (dysphagia) or a sensation of a lump in the throat (globus sensation).
• Regurgitation of stomach juices and nausea.
• A hoarse voice.

If symptoms are continual or severe, you may have gastroesophageal reflux disease (GERD), which is the abnormal backflow (reflux) of food, stomach acid, and other digestive juices into the esophagus that lasts longer and occurs more often than ordinary heartburn. Hiatal hernia and GERD often occur together. Treatment for GERD usually requires stronger prescription medications, and surgery may be an option. For more information, see the topic Gastroesophageal Reflux Disease (GERD).

If you have shortness of breath or pain in the area of your breastbone, you need to make sure it is not caused by a heart problem. The burning sensation caused by reflux usually occurs after eating. Pain from your heart is usually felt as pressure, heaviness, a weight, tightness, squeezing, discomfort, or a dull ache that occurs most often after activity. To learn more about chest pain that may indicate problems with your heart, see the topic Chest Pain.

Large sliding hiatal hernias may cause a complication called Cameron ulcers, which are erosions on the folds of the stomach near the opening (hiatus) in the diaphragm where the esophagus passes through. When endoscopy is used to view the hernia, Cameron ulcers are found in about 5% of people with hiatal hernias.¹ Sometimes Cameron ulcers can cause mild internal bleeding in the intestines.

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Author:	Colleen Cronin	Last Updated: April 7, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology
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