Hiatal hernia

Dear Alice,

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

Dear Reader, 

A hiatal hernia is when the upper part of the stomach moves into the chest via a small hole in the diaphragm, the muscle that separates the stomach from the chest. This small hole, often referred to as the hiatus, connects the esophagus (“food tube”) to the stomach. There are two types of hiatal hernias. A sliding hernia, which is the most common type, occurs when the stomach slides up into the chest and esophagus through the hiatus. A paraesophageal hernia, which is usually less common but more severe, occurs when the stomach protrudes through the hiatus next to the esophagus. Among other symptoms, some people may experience shortness of breath (more on the symptoms later!). While both can be quite painful conditions, most individuals with minor hiatal hernias can experience mild to no pain at all. 

Since you asked whether these kinds of hernias can cause shortness of breath, it can be helpful to start with symptoms. Given that the stomach assumes space in the chest when a hiatal hernia occurs, leaving less room for the lungs to function at capacity, this can sometimes cause those with hiatal hernias to experience shortness of breath. Additionally, these types of hernias can also cause: 

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

While shortness of breath and chest pain can both be symptoms of a hiatal hernia, these symptoms can also stem from several other health conditions as well. Moreover, while hiatal hernias can affect anyone of any age, gender, or race/ethnicity. It primarily affects those who are 50 years of age or older because the diaphragm is more likely to be weakened, which would allow for the stomach to bulge through. In addition, hiatal hernias are also more common in individuals who smoke and those 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. This involves the patient drinking a chalky beverage containing the chemical barium, which allows for the workings of the stomach to be more visible on an x-ray. Additionally, they may perform an endoscopy, which is when a small tube with a light and video camera is inserted down the throat. This procedure is designed to check for inflammation in the esophagus and stomach. In cases where symptoms can’t be managed by other means, such as taking prescribed or over-the-counter medications that reduce or block acid production, surgery may be an option to repair a hiatal hernia. 

Lastly, in addition to the treatment options mentioned above, ways to reduce these symptoms (particularly the ones associated with heartburn and acid reflux) could include: 

  • Avoiding certain foods, such as acidic, fatty or fried foods 
  • Limiting the amount of caffeine, alcohol, and carbonated beverages in your diet 
  • Trying not to lie down right after a meal 
  • Trying not to eat anything before going to bed 
  • Losing weight if you are overweight 
  • Maintaining a healthy weight 
  • Keeping your head raised six inches higher than the rest of your body when you are lying down on your back 
  • Abstaining from smoking 

If you experience any of these symptoms or symptom management is unsuccessful, 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. They may also be able to provide treatments that may better suit your needs.  

Hope this information helps! 

Last updated Jul 23, 2021
Originally published Jan 21, 2005