Dear Alice,

What is a hiatial hernia and its symptoms? Can it cause shortness of breath??

Dear Reader,

A hiatal hernia is defined as the movement of the stomach into the chest via a hiatus (a hole) in the diaphragm. Anatomically, the diaphragm muscle is between the stomach and the chest. The hiatus is the opening in the diaphragm where the esophagus or food pipe joins the stomach. A hiatal hernia, then, occurs when the stomach bulges into the chest via the hiatus in the diaphragm. There are two types of hiatal hernias: a sliding hernia is when the stomach slides up into the chest and back down; a paraesophageal hernia is when the stomach slides up into the chest and stays there. Both can be quite painful conditions, although some minor hiatal hernias can cause mild to no pain.

Because the stomach assumes space in the chest, leaving less room for the lungs to function at capacity, yes, large or severe hiatal hernias can sometimes cause shortness of breath. Hiatal hernias can also cause:

  • Chest pain
  • Heartburn and acid reflux
  • Belching
  • Difficulty swallowing
  • Abdomen pain
  • Stomach ulcers

Although shortness of breath and pain around the breastbone area can be caused by a hiatal hernia, these can also stem from a number of other health conditions as well. If you experience any of these symptoms, it's a good idea to check in with a health care provider to make sure a more severe underlying condition isn't at work. Other warning signs that require medical evaluation include dizziness, irregular heartbeat, and nausea or vomiting.

Hiatal hernias usually affect people older than 50 years because the diaphragm is more likely to be weakened which would allow for the stomach to bulge through. Hiatal hernias are also more common in women and people who are overweight or obese.

In order to diagnose a hiatal hernia, a health care provider may perform a simple chest x-ray, possibly with a barium swallow (after drinking a chalky beverage containing the chemical barium, the workings of your stomach will be more visible on x-ray). An endoscopy (where a small tube with a light and video camera is inserted down your throat) may also be used to check for inflammation in the esophagus and stomach. In cases where symptoms cannot be managed by other means (i.e. medications that reduce or block acid production), surgery may be an option to repair a hiatal hernia.

Lastly, in addition to these treatment options, you may be able to reduce symptoms (particularly the ones associated with heartburn and acid reflux) by:

  • Avoiding large meals;
  • Remaining upright after a meal;
  • Reducing body weight if you are overweight (and by maintaining a healthy weight); and
  • Abstaining from smoking.

Hope this information helps!


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