The complications of hiatus hernia range from mild to life-threatening, depending on the type, size, and severity of the hernia and how promptly it is managed.
Many people live with small, sliding hiatus hernias and feel no symptoms. But others may develop serious problems in the stomach, lungs, or even need surgery if they ignore the condition. Knowing the possible complications of hiatus hernia helps both patients and doctors make better choices and take action early.
Digestive Damage from Ongoing Reflux
One of the most common problems is acid reflux, also called GERD. When part of the stomach pushes through the diaphragm, the valve that stops acid from coming up may stop working. This lets acid and food flow back into the food pipe. As a result, people feel heartburn, taste sour liquid, or burp up food. Over time, the acid can hurt the food pipe and cause real damage. So, GERD is both a symptom and a serious complication of hiatus hernia.
If the reflux keeps happening, it can lead to reflux oesophagitis. This means the lining of the oesophagus becomes red, swollen, and even gets tiny sores. If left untreated, these sores may turn into ulcers. Ulcers can bleed and cause chest pain, trouble swallowing, and even vomiting with blood. They are painful and risky. They also raise the chance of more serious problems like narrowing of the food pipe or, in rare cases, holes forming.
Sometimes, long-term irritation creates scar tissue. This causes the oesophagus to narrow—a problem called a stricture. Food then feels stuck, or people notice trouble when swallowing. Doctors may need to use a small tube to gently stretch the narrow part. This helps food pass again. But sadly, strictures often return and may need this process more than once.
Barrett’s Oesophagus and Cancer Risk
One of the most serious complications of hiatus hernia is Barrett’s oesophagus. When acid keeps rising into the food pipe, the normal cells change into cells more like those in the stomach. Doctors call this a pre-cancer condition. It raises the chance of getting a rare but deadly cancer called oesophageal adenocarcinoma. The good news is that regular checks using a camera (endoscopy) and small tissue samples (biopsies) can catch changes early. Early treatment can stop cancer from developing.
Dangerous Twisting and Blockage
Some people develop a different type of hernia called a para-oesophageal hernia. Unlike sliding hernias, these push the stomach up next to the oesophagus. This makes twisting of the stomach more likely, which doctors call gastric volvulus. When this happens, food can’t pass through, and people may feel sharp pain in the chest or top of the belly, try to vomit but can’t, or have a hard time swallowing. If the blood supply to the stomach gets cut off, part of the stomach may start to die. This is called strangulation and is very dangerous. Doctors need to operate right away to save the person’s life.
Breathing Problems and Lung Risks
Big hiatus hernias can also affect breathing. Stomach acid may rise high enough to enter the throat or even the lungs. This leads to coughing, a raspy voice, or wheezing like asthma. At night, this reflux is worse because the person is lying down. Acid going into the lungs during sleep may cause pneumonia again and again. Over time, this may reduce lung strength, especially in older people or those with weak immune systems.
Other Physical Effects from Chronic Irritation
Sometimes the hernia causes bleeding in small amounts over time. People may not notice, but this slow loss of blood can lead to iron-deficiency anaemia. This makes people feel tired, weak, short of breath, or pale. Doctors often find this in older adults and check the oesophagus to see if a hiatus hernia is the cause. A scope test usually helps confirm the problem.
Another symptom that causes worry is chest pain that feels like a heart attack. When the hernia pushes into the chest, it can cause pain behind the breastbone. This pain may spread to the jaw, arm, or neck. Although it’s not from the heart, the feeling can cause panic. Many people end up in the hospital, thinking it’s heart trouble. Doctors need to rule out heart problems using scans and tests before linking it to the hernia.
Surgical and Long-Term Complications
Surgery can fix many of these problems, but it also comes with risks. Modern methods like keyhole surgery (laparoscopic fundoplication) work well. Still, people may have bloating, trouble burping, or feel too full after eating. Some might have swallowing problems or get infections. In rare cases, the hernia comes back, or nearby organs like the spleen get hurt. Skilled surgeons and close care after surgery help avoid these issues.
The complications of hiatus hernia can get worse over time if not treated. A small hernia with no symptoms can grow into a large one with serious risks. Things that raise pressure in the belly—like being overweight, coughing a lot, or pushing too hard during bowel movements—can make the hernia worse. This is why it’s important to manage the problem early, even when there are no symptoms.
Preventing Serious Complications of Hiatus Hernia
To sum up, the complications of hiatus hernia can affect the stomach, lungs, and even raise cancer risk. GERD, reflux damage, ulcers, narrowing of the oesophagus, Barrett’s, twisting of the stomach, bleeding, lung infections, and chest pain are all possible problems. Luckily, most of these can be avoided. Early diagnosis, healthy habits, the right medicine, and surgery when needed can protect people from getting worse. Catching the signs early and working closely with a doctor helps people stay well and enjoy life without symptoms.
