A hiatal hernia (HH) occurs when a portion of the stomach pushes upward through the diaphragm, the muscular sheet separating the chest and abdomen. While this condition commonly causes discomfort, some individuals with hiatal hernias also report episodes of dizziness or vertigo. Although a direct causal relationship is not recognized clinically, several indirect physiological mechanisms may link the two experiences.
Anatomy and Types of Hiatal Hernia
A hiatal hernia forms at the esophageal hiatus, the opening in the diaphragm through which the esophagus passes to the stomach. When this opening widens, a part of the stomach protrudes into the chest cavity. The condition is classified into two main types based on how the stomach moves.
The vast majority (90 to 95%) are Type 1, known as a sliding hiatal hernia. In this common form, the gastroesophageal junction slides up and down through the hiatus. The second main category is the paraesophageal hernia, where a part of the stomach bulges up alongside the esophagus while the junction remains in place. This type is less common but can be more serious due to the risk of the stomach becoming trapped or losing its blood supply.
Primary Symptoms Associated with Hernias
The established symptoms of a hiatal hernia are overwhelmingly gastrointestinal in nature. The most common manifestation is chronic acid reflux, or Gastroesophageal Reflux Disease (GERD), which occurs when stomach acid backs up into the esophagus. This acid backflow causes heartburn, typically worsening after meals or when lying down.
Other symptoms include regurgitation of food or sour liquid, difficulty swallowing (dysphagia), and chest discomfort that can sometimes be mistaken for cardiac pain. Patients may also report feeling full soon after eating or experiencing shortness of breath if the hernia is large. Dizziness or spinning is not considered a standard symptom in the clinical presentation of a hiatal hernia.
Exploring the Hiatal Hernia-Dizziness Link
While the hernia does not directly target the balance system, the gut-brain connection is often cited as the mechanism for dizziness. The most widely discussed indirect cause is irritation of the vagus nerve, which runs alongside the esophagus. Excessive stomach distention or inflammation from severe acid reflux can mechanically or chemically stimulate this nerve.
The vagus nerve is a major component of the parasympathetic nervous system, and its overstimulation can trigger the “vagal reflex.” This reflex can lead to a sudden drop in heart rate and blood pressure, known as vasovagal syncope or presyncope. The resulting temporary reduction of blood flow to the brain causes sensations of lightheadedness, faintness, or mild dizziness.
Chronic symptoms and pain associated with a hiatal hernia can also induce stress and anxiety. Anxiety often manifests with physical symptoms like hyperventilation, which disturbs carbon dioxide levels and can directly cause feelings of wooziness or unsteadiness. Furthermore, some medications used to manage GERD and hiatal hernia, such as certain acid-reducing drugs, occasionally list dizziness as a side effect.
Other Common Causes of Dizziness
Since a hiatal hernia is an infrequent direct cause of dizziness, it is helpful to consider other common alternative explanations. Many cases of true vertigo, the sensation that the room is spinning, stem from issues within the inner ear. Conditions like Benign Paroxysmal Positional Vertigo (BPPV) are caused by the displacement of tiny calcium crystals in the ear canals, which disrupts balance signals to the brain.
Dizziness can also be circulatory, often linked to changes in blood pressure, such as orthostatic hypotension, where a person feels faint upon standing up too quickly. Dehydration, low blood sugar (hypoglycemia), and migraines can also trigger lightheaded or unsteady feelings. If dizziness is persistent, severe, or accompanied by symptoms like chest pain or a rapid heartbeat, a medical professional should be consulted to rule out serious causes and determine the correct diagnosis.