People with a hiatal hernia can experience heartburn, often after eating. When the hernia is larger, it can also cause pain or pressure in the chest if it affects the heart and lungs.

A hiatal hernia is where the upper part of the stomach, or another internal organ, bulges through the opening in the diaphragm, called the hiatus.

The diaphragm is a thin muscle separating the abdomen and the chest. It helps stop acid from coming up into the esophagus, or food pipe. A hiatal hernia makes it easier for acid to reach the esophagus.

This article looks at what chest pain from a hiatal hernia feels like, whether chest pain signifies that a hernia is worsening, treatment options, and when to contact a doctor.

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Hiatal hernia can cause chest pain and has associations with the following conditions.

Gastroesophageal reflux disease (GERD) and heartburn

In many cases, chest pain from a hiatal hernia has links to acid and the contents of the stomach traveling up to the esophagus.

This is called gastroesophageal reflux disease (GERD) and can cause a person to experience heartburn. Heartburn feels like a burning sensation in the middle of the chest and can cause a foul, acidic taste in the mouth.

According to a 2019 article, the chest pain related to GERD can feel similar to the pain associated with a heart attack. The pain can also occur without heartburn.

Additionally, GERD can cause the muscles in the esophagus to spasm. This can also cause a person to experience chest pain that they could mistake for a heart attack.

Heart and respiratory system

Hiatal hernias can affect the respiratory system, which may also cause pain or pressure in the chest.

As the hernia enlarges and takes up more space, it can compress the arteries in the heart and lungs. This may cause a part of the lung to collapse, which can lead to the following:

  • trouble breathing
  • an intense tightness in the chest
  • shortness of breath

Hiatal hernias may also cause pressure on the heart, called tamponade. The hernia can compress the heart, causing shortness of breath and chest discomfort.

Chest pain can signify a strangulated or worsening hiatal hernia.

A hernia becomes strangled when the blood supply to the hernia is cut off.

A doctor may suspect that a hiatal hernia is strangulated if a person has severe chest or upper abdominal pain, usually after a meal. In this scenario, individuals may also experience retching and vomiting.

If people suspect their hernia is worsening, they should contact a doctor.

Depending on the severity of a hiatal hernia, a person may not require medical treatment.

A 2022 article notes that while hiatal hernias are common and affect up to 60% of individuals over 50 years of age, only 9% experience symptoms. People who do not experience symptoms do not require medical treatment.

Home treatment and management

The following can help manage the symptoms of a hiatal hernia:

  • stopping smoking, if applicable
  • eating small meals
  • avoiding oily or fried foods
  • avoiding caffeine
  • avoiding alcohol
  • maintaining a moderate weight
  • taking over-the-counter (OTC) antacids
  • being upright while eating
  • eating at least 3 hours before going to bed

Medical treatment

If a person experiences symptoms of a hiatal hernia, such as GERD, they may require medical treatment.

This may involve using proton pump inhibitors, which are medications to treat heartburn, acid reflux, GERD, and stomach ulcers. Doctors may also recommend surgical procedures.

Procedures and surgeries include:

  • Transoral incisionless fundoplication: This procedure does not involve incisions. A doctor places an endoscope down the throat and into the esophagus to tighten it. They then wrap parts of the stomach — the cardia and the fundus — around the esophagus.
  • Endoluminal fundoplication: A doctor places an endoscope, a tube that attaches to a camera and light, down the throat. They then tighten the area where the esophagus joins the stomach to prevent acid from flowing into the esophagus.
  • Endoscopic anterior fundoplication with the Medigus Ultrasonic Surgical Endostapler: A doctor uses surgical staples to attach the fundus to the esophagus. This procedure stops acid reflux.
  • Nissen fundoplication: Surgeons can perform this procedure laparoscopically, which means through tiny incisions. They insert a laparoscope, a tube with a camera and light attached, to repair the hernia and tighten the stomach opening.
  • Open surgery: This involves the surgeon making a larger incision into the abdomen. The surgeon pulls the stomach up into the abdominal cavity and wraps the fundus around the lower part of the food pipe. This prevents acid from leaking up into the esophagus.

Someone should contact a doctor if they experience chest pain, whether they believe it is due to a hiatal hernia. Chest pain may indicate a serious medical condition, such as a heart attack.

Individuals should also contact a doctor if their symptoms:

  • persist for longer than 3 weeks
  • do not resolve from using OTC antacids
  • worsen

A hiatal hernia can cause a person to experience chest pain. One of the most common presentations of a hiatal hernia is GERD. GERD can cause a person to experience heartburn, causing discomfort and pain in the chest.

It can also cause the esophageal muscles to spasm, resulting in chest pain that feels similar to chest pain relating to a heart attack.

Other causes of chest pain from a hiatal hernia are pressure on the lungs or chest due to the expansion of the hernia. These may cause shortness of breath and chest discomfort.

Severe chest pain, along with some other symptoms such as retching and fever, may indicate that a hiatal hernia is strangulated.

This is a medical emergency, and anyone with these symptoms should seek immediate emergency medical assistance.

People should also seek medical attention immediately if they experience chest pain. This is because chest pain can be a sign of a heart attack.