The larger the hernia, the more likely it is to cause symptoms.  The vast majority of hiatal hernias are known as a "sliding hiatal hernia", and most are not associated with symptoms. When sliding hiatal hernias produce symptoms, they almost always mimic those of gastroesophageal reflux disease (GERD) or its complications. Additionally, it is known that patients with GERD are much more likely to experience a hiatal hernia than individuals not afflicted by GERD.

Small hiatal hernia
Most small hiatal hernias cause no problems.  In fact, signs and symptoms of a hiatal hernia may imitate those of regular indigestion or digestive problems.  These signs and symptoms of a hernia tend to become worse when you lean forward, strain, lift heavy objects or lie down, and they can also worsen during pregnancy.  Hiatal hernia symptoms may be especially pronounced after a meal.  Symptoms of a hiatal hernia include:

• Abdominal discomfort
• Acid reflux
• A dry cough
• Bad breath
• Belching
• Chest pain
• Gas
• Heartburn
• Nausea

Large hiatal hernia
A hiatal hernia occurs when a portion of the stomach that has been pulled up into the chest above the breathing muscle, or the diaphragm. Normally, the stomach is entirely in the abdomen.  When the stomach is pulled above the diaphragm (which separates the chest from the abdomen), a bit of the stomach is in the chest. Therefore, a hiatal hernia can appear to be entirely normal, in that the tissue looks completely normal.

Sometimes, in rare cases, the part of your stomach that protrudes into your chest cavity may become twisted (strangulated) or have its blood supply cut off, leading to a large hiatal hernia.  Symptoms of a large hiatal hernia include:

• Belching
• Chest pain
• Difficulty swallowing, also called "dysphagia"
• Esophagus obstruction
• Heartburn
• Nausea
• Severe chest pain

When to seek medical help
Many people discover they have hiatal hernias when they see their doctors about heartburn. But if your symptoms are severe, occur often, or are accompanied by coughing, wheezing, asthma, a sore throat, difficulty swallowing or chest pain, talk to your doctor. Call your doctor if symptoms indicate you may have developed a hiatal hernia, if you have a hiatal hernia and symptoms worsen or do not improve with treatment, or if new symptoms develop.  To learn more about how doctors diagnose hiatal hernia pain, read the Diagnosing Hiatal Hernia section that follows.