Hiatal Hernia Pain Locations and Characters: Gastroenterologist Explains.

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Hiatal hernia can be painless or asymptomatic in most cases of the small and uncomplicated types.

Hiatal hernia pain is typically located in the front of your chest felt heartburn. Other less common locations of hiatal hernia pain include epigastric pain and back pain.

Hiatal hernia can also cause GERD-related chest pain, which is squeezing or compressing in nature. This type of pain can mimic anginal pain (heart attack).

Continue reading this in-depth, evidence-based explanation of the different characters and locations of hiatal hernia pain.

1. Burning pain in the chest (heartburn).

The most common symptom of hiatal hernia is acid reflux (GERD). This is because a hiatal hernia causes the acid inside your stomach to reflux back into the esophagus.

The refluxed acid leads to inflammation and erosions in the lower part of your esophagus. This will cause a burning sensation in the front of your chest (heartburn).

The pain results from the inflamed esophagus and not from the hiatal hernia itself. But is the most common type of pain associated with a hiatal hernia.

GERD is the commonest among the type I hiatal hernia (esophageal hernia).  Other types of Hiatal hernia (type II, III, IV, or para esophageal hernia) typically don’t cause heartburn (reference).

Symptoms suggesting that heartburn is due to hiatal hernia:

  • The heartburn increases after meals.
  • Regurgitation of food particles or bitter material up to the throat.
  • Nausea.
  • Difficulty swallowing.
  • Vomiting.
  • Fullness after eating.
  • Shortness of breath after eating.

The symptoms of a hiatal hernia with acid reflux are not different from the GERD without a hiatal hernia. Your doctor is the only one who can differentiate them.

Differentiation is confirmed by (reference):

  • X-ray with a barium dye swallow.
  • Upper gastrointestinal endoscopy.

2 . Upper-middle abdominal pain and fullness (epigastric pain).

The second most common hiatal hernia pain location is the upper-middle abdomen. This area of your abdomen is called the (epigastric area).

This location is famous for gastritis pain. This type of pain occurs more often with the paraesophageal hernias.

With a paraesophageal hernia, part of your stomach can get stuck inside the chest cavity. As a result, this part is not functional and cannot receive food.

The capacity of the remaining part of your stomach will become significantly low. This will lead to rapid filling of your stomach with little amounts of food.

Symptoms include:

  • The fullness of the epigastric area after eating very little.
  • Epigastric pain or discomfort after eating.
  • Nausea after eating.
  • Recurrent vomiting after eating or drinking minimal amounts.
  • Increase in GERD symptoms (heartburn and regurgitation).

When the hiatal hernia pain is located in the epigastric area, it can be confused with gastritis and functional dyspepsia. However, the epigastric hiatal hernia pain and fullness don’t improve by anti-acid drugs.

The persistence of epigastric pain or discomfort despite gastritis or functional dyspepsia treatment can signify hiatal hernia. Therefore, your doctor will often perform an endoscopy to differentiate the causes.

3. GERD-related chest pain (similar to the pain from a heart attack).

Hiatal Hernia with severe GERD can cause a different type of chest pain than classic heartburn. However, the pain is severe, compressing chest pain in front of your chest mimicking the angina pectoris pain (heart attack).

This type of pain is called GERD-related chest pain; it has the following characters (reference):

  • Squeezing or heaviness in the front of your chest (behind the sternal bone).
  • The pain radiates to the back, jaw, or two arms (similar to heart attack pain).
  • The pain lasts anywhere from minutes to hours.
  • The pain resolves spontaneously or with antacids.

So, The hiatal hernia pain can be located in atypical locations such as in the jaw, arms, or back when severe GERD complicates it.

Differences between hiatal hernia pain and anginal pain (heart attack):

The differentiation can be difficult based on symptoms only. Consult your doctor immediately if you have typical chest pain for a heart attack.

The exclusion of anginal pain is essential because it is a life-threatening medical condition. You must seek medical advice; ECG (electrocardiogram) and cardiac enzymes (troponin) will help rule out the anginal pain.

The differences in symptoms include:

  • The hiatal hernia pain typically starts after meals, while the heart attack typically starts after physical effort.
  • Hiatal hernia pain worsens at night (laying flat triggers acid reflux).
  • Other reflux symptoms are present with hiatal hernia (heartburn, nausea, regurgitation of bitter material, vomiting, etc.).
  • The hiatal hernia pain located in the chest typically resolves after taking an antacid or proton pump inhibitor (as omeprazole).
  • The heart attack pain typically resolves by rest or taking sublingual nitrates (coronary artery dilator).
  • Investigations that help the differentiation include ECG (electrocardiogram, Cardia troponin, Upper endoscopy, Coronary angiography, and esophageal PH monitoring (reference)

4. Backpain.

Hiatal hernia can cause back pain radiating from heartburn. Backpain from a hiatal hernia is typically associated with burning chest pain in the front of your chest.

Hiatal hernia-related back pain is often located in the upper-middle back in the middle between shoulder blades. It is often associated with other Hiatal hernia symptoms as heartburn, regurgitation, nausea, or vomiting.

Also, atypical GERD-related chest pain that is similar to a heart attack pain radiates to the back.

It is unlikely for hiatal hernia or GERD to cause isolated back pain without their other typical symptoms.

It is better to think of alternative causes of isolated back pain other than Hiatal herniae such as spine or disc problems.

5. Non-painful hiatal hernia.

Most type I Hiatal hernias (sliding) are small in size. Small-sized Hiatal hernias typically have NO SYMPTOMS at all (reference).

In types II, III, IV (Paraesophageal hernias), the hernia has no or vague symptoms other than pain. However, if you have an uncomplicated paraesophageal hernia, Your symptoms can be vague and intermittent.

atypical or vague symptoms include:

  • Recurrent nausea.
  • Recurrent fullness after eating.
  • Intermittent difficulty in swallowing (dysphagia).
  • Intermittent discomfort in the chest or the upper-middle abdomen.
  • Early satiety.
  • Shortness of breath after eating.

The key point I want you to know is that pain is not always present with a Hiatal hernia. Small and non-complicated sliding (type1) and para esophageal hernias have no symptoms at all (reference).

LEARN MORE: 7 Hiatal hernia weird symptoms you should know.