A hiatal hernia can cause difficulty swallowing, known as dysphagia. This condition occurs when a portion of the stomach protrudes through an opening in the diaphragm, the muscle separating the chest and abdominal cavities. Understanding the connection between these two conditions is important for those experiencing symptoms.
What is a Hiatal Hernia
A hiatal hernia occurs when the upper part of the stomach pushes up through an opening in the diaphragm, called the esophageal hiatus, and into the chest cavity. The diaphragm is a dome-shaped muscle that acts as a barrier between the abdomen and chest. This condition is common, affecting about 20% of the U.S. population and increasing with age.
There are two primary types of hiatal hernias. A sliding hiatal hernia is the most common, where the stomach and lower esophagus slide up into the chest. Less common are paraesophageal hernias, where a part of the stomach bulges up alongside the esophagus.
How a Hiatal Hernia Affects Swallowing
A hiatal hernia can lead to difficulty swallowing. The herniated part of the stomach can directly press on the esophagus, making it harder for food and liquids to pass. This pressure can create a sensation of food getting stuck or an uncomfortable feeling during swallowing.
Hiatal hernias often worsen gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus. This happens because the hernia can disrupt the lower esophageal sphincter, a muscle that prevents acid from flowing upward. Chronic exposure to stomach acid can inflame the esophageal lining, known as esophagitis, causing pain and swallowing problems. Over time, this inflammation can lead to scar tissue, narrowing the esophagus into an esophageal stricture, which further impedes swallowing.
Other Signs and When to See a Doctor
Beyond difficulty swallowing, hiatal hernias can cause other symptoms. Common signs include:
Heartburn, a burning sensation in the chest often occurring after eating.
Acid regurgitation, where stomach contents flow back into the throat or mouth.
Non-cardiac chest pain.
Indigestion.
Feeling full quickly after eating.
Belching.
Nausea.
Sore throat and hoarseness due to acid irritation.
Pressure or pain in the upper abdomen (especially with larger paraesophageal hernias).
Consult a healthcare provider if you experience persistent difficulty swallowing. Seek prompt medical attention if you have additional concerning symptoms such as pain with swallowing, unexplained weight loss, or if food consistently feels stuck. Emergency care is needed for sudden, severe chest pain, vomiting, fever, chills, or blood in stool, as these could indicate serious complications like strangulation of the hernia, where blood supply is cut off.
Treatment Approaches
Managing hiatal hernia symptoms, including difficulty swallowing, often involves lifestyle adjustments. Eating smaller, more frequent meals can reduce pressure on the stomach and lessen acid reflux. Avoiding trigger foods such as fatty or fried foods, citrus, chocolate, caffeine, and alcohol can help alleviate symptoms. Not eating for a few hours before bedtime and elevating the head of your bed by six to eight inches can also help prevent acid reflux while sleeping.
Over-the-counter medications like antacids provide short-term relief for heartburn. For persistent symptoms, healthcare providers may recommend prescription medications such as H2 receptor blockers, which reduce acid production, or proton pump inhibitors (PPIs), which block acid production and allow the esophagus to heal. These medications manage symptoms but do not resolve the hernia itself. Surgery is considered in severe cases where medications and lifestyle changes are insufficient, or if complications like strangulation occur. Surgical repair involves moving the stomach back into the abdomen and tightening the opening in the diaphragm.