Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
Most hiatal hernias are small and cause only heartburn. A large one is different. When a big part of the stomach sits above the diaphragm, it takes up room in the chest.
This page explains the chest symptoms a large hernia can cause, why the heart comes first, and when repair is considered.
Pain from the food pipe and stomach can feel exactly like heart pain. Both sit behind the breastbone. So anyone with new chest pain, especially pain that comes with effort, sweating or breathlessness, needs a heart check first.
An ECG and, where needed, further heart tests come before any hernia work-up. If the heart is normal, the hernia is looked at next. A normal heart test does not mean the pain is in your mind.
Chest symptoms and what they may point to
| Symptom | May come from | Usual first step |
|---|---|---|
| Burning behind the breastbone after meals | Acid reflux | Diet changes and acid tablets |
| Pressure or fullness in the chest after eating | Stomach filling inside the chest | Endoscopy and CT scan |
| Breathless after meals, better later | Hernia pressing on the lung | Chest and heart check, then CT |
| Pain on effort, with sweating | The heart | ECG and heart tests first |
| Tiredness, low haemoglobin | Slow bleeding in the hernia | Blood tests and endoscopy |
Chest pressure or breathlessness after meals, with a hiatal hernia on your report? Bring your heart tests and scans.
A large hernia causing breathlessness, food sticking, anaemia or repeated pain is usually repaired. The stomach is brought back into the belly, the gap in the diaphragm is narrowed, and the stomach is fixed so it stays down.
In an older person, the decision weighs their general health against the risk of the hernia getting worse. A large hernia with no symptoms may simply be watched.
Emergency signs of a twisted hernia
This is rare, but it is an emergency. Go to the nearest emergency department and tell them you have a hiatal hernia.
Yes. Acid reflux and a large hernia pressing in the chest can both cause chest pain. Because heart pain can feel the same, the heart is checked first.
With a large hiatal hernia, part of the stomach sits in the chest. After a meal it fills and presses on the lung, which can make you short of breath.
Yes. A large hernia can cause slow bleeding from the stomach lining. Low haemoglobin with no other cause is one reason to look for it.
Rarely, the part of the stomach in the chest twists. This causes sudden severe chest or upper belly pain, retching with little coming up, and needs emergency care.
Not always. If it causes symptoms such as breathlessness, food sticking or anaemia, repair is usually advised. A large hernia with no symptoms may be watched.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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