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Hiatal Hernia Causes & Symptoms


The exact cause of hiatal hernias is unknown. They are mostly caused by weakening of the muscles of the diaphragm around the esophagus. Other causes that increase the intra-abdominal pressure such as pregnancy will contribute to formation of hiatal hernias


Small sliding hiatal hernias (Type I hiatal hernia) can be asymptomatic (not causing any problem). The most common symptoms associated with symptomatic hiatal hernias are the following:

  • Heartburn
  • Regurgitation
  • Difficulty swallowing
  • Chest pain
  • Anemia
  • Chronic cough

Heartburn: Symptomatic patients with hiatal hernia present with reflux disease and complain of heartburn, mostly after eating or at night. About 80 percent of patients with a paraesophageal hiatal hernia (type II hiatal hernia) have heartburn and have an increased amount of acid detected on pH monitoring (studies that detect acid in the esophagus).

Regurgitation: Foods can remain in the hiatal hernia and return back into the mouth. Type II and type III hiatal hernia can result in mechanical obstruction of the lower part of the esophagus, causing regurgitation of the food into the mouth after eating. This can be associated with a bitter taste in the mouth in patients with reflux disease.

Dysphagia (difficulty swallowing): Hiatal hernias can cause obstruction and delay in emptying of the lower part of the esophagus and the stomach, resulting in dysphagia.

Chest pain: The chest pain commonly occurs postprandially (after eating) and is substernal (behind the breast bone) in location, giving rise to concern that the chest pain is cardiac in origin.

Anemia: Anemia is the most common laboratory finding in patients with paraesophageal (type II) hiatal hernia, and results from damage and ulceration to the lining of the stomach due to compression of the stomach at the level of esophageal hiatus (see image below).

Chronic cough: Chronic cough is caused by aspiration of acid particles in the airway. It is also known that the presence of acid in the esophagus can cause a reflex phenomenon in the airway and cause cough.

By Farzaneh Banki, M.D.