Hiatal Hernia and Shortness of Breath: Symptoms & Treatment

A hiatal hernia is a common medical condition that affects many people. It occurs when part of the stomach moves up into the chest through an opening in the diaphragm.

The condition can be painful and bothersome, but with early diagnosis and the right treatment its effects can be overcome successfully.

In this article we look in detail at what a hiatal hernia is, why it happens, the symptoms it causes, how it is diagnosed, and the treatment options available at Town Hospital.

What Is a Hiatal Hernia?

The diaphragm is an important muscle that separates the chest cavity from the abdominal cavity. In a hiatal hernia, part of the stomach slips out of its normal position in the abdomen and moves up into the chest through an opening in the diaphragm.

Symptoms of a Hiatal Hernia

Most often, no symptoms at all: In most cases a hiatal hernia causes no symptoms and is found by chance during an upper endoscopy or an imaging test done for another reason. A small sliding hernia that causes no symptoms does not in itself require treatment, and follow-up with a doctor is enough. The severity of symptoms does not reliably match the size of the hernia: someone with a small hernia may have a great deal of discomfort, while someone with a large hernia may feel nothing at all.
Heartburn and acid reflux: This is the most prominent symptom when symptoms do appear. It is felt as a burning sensation behind the breastbone, or as sour or bitter fluid rising into the throat and mouth.
Symptoms that get worse in certain positions: Symptoms increase after rich, fatty meals, when lying down, and when bending forward, and they may wake the patient from sleep at night.
Indigestion, frequent belching, and bloating after eating.
A feeling of pressure or fullness in the upper abdomen and behind the breastbone, along with feeling full before finishing a meal. This is most noticeable with a large hernia.
Nausea and vomiting.
Difficulty swallowing, or a sensation of food sticking on the way down: Difficulty swallowing is not an everyday symptom to simply live with, and it must not be blamed on the hernia without a proper evaluation. If it is new, if it is getting worse, if food becomes stuck, or if it comes with unintentional weight loss, the patient must be seen by a doctor and have an upper endoscopy to rule out narrowing of the esophagus caused by long-standing reflux, a ring that narrows the esophagus, or tumors of the esophagus.
Breathing and voice symptoms: Reflux can come with a persistent cough, hoarseness, throat irritation, and episodes of choking or gagging during sleep, and asthma symptoms may flare in people who have asthma. However, these symptoms have many other, more common causes, including smoking, respiratory allergy, postnasal drip, and disorders of the voice box, so they must not be blamed on reflux without a medical evaluation.
Shortness of breath with a large hernia: A large hernia can cause shortness of breath, especially after eating, because of the pressure of the part of the stomach that has moved up into the chest cavity.
Iron-deficiency anemia: Fatigue, pallor, and low iron stores can develop as a result of slight, ongoing bleeding from tiny erosions in the stomach wall at the level of the opening in the diaphragm, caused by repeated rubbing. With a large hernia this may be the only sign. However, iron-deficiency anemia must not be blamed on the hernia without a complete workup of the upper and lower digestive tract to rule out other sources of bleeding, above all tumors of the colon. Blaming the hernia without that workup is a mistake that can delay the diagnosis of a more serious disease.
Signs that mean seeing a doctor without delay: Unintentional weight loss, repeated vomiting, symptoms that persist or worsen despite treatment and sticking to the dietary changes, or heartburn that appears for the first time later in life.
What this hernia does not cause: This is an internal hernia, in which part of the stomach moves up into the chest cavity. It does not produce a visible bulge under the skin, a lump that can be felt with the hand, swelling in the groin, pain or swelling in the lower abdomen, or a bulge that appears on standing, coughing, or exertion and then disappears on lying down. Those are the signs of an inguinal hernia or an abdominal wall hernia, which is an entirely different condition.
Chest pain is never blamed on the hernia automatically: Reflux pain can closely resemble pain coming from the heart. If chest pain comes with shortness of breath, heavy sweating, dizziness, or pain spreading to the arm, neck, or jaw, emergency medical help must be sought immediately, before assuming the cause is digestive.
Signs that mean going to the emergency department right away: Sudden, severe pain in the chest or upper abdomen; continuous vomiting; severe nausea with retching that brings nothing up; complete inability to swallow even saliva; vomiting blood; or black, tarry stools. Any of these signs means going to the emergency department immediately, no matter which type of hernia was diagnosed previously. They can mean that the stomach has become trapped in the opening in the diaphragm, or has twisted with its blood supply reduced. This complication is seen mainly in the paraesophageal type, which accounts for about five percent of hiatal hernias, and it is a situation that cannot wait.

Causes of Hiatal Hernia and Risk Factors

How the hernia forms: The esophagus travels from the chest down into the abdomen through an opening in the diaphragm called the esophageal hiatus, where a connecting membrane anchors it to the diaphragm. When that membrane loosens and the opening widens, the top of the stomach is pushed up into the chest. More than 90% of these hernias are type I, the sliding type, in which the junction between the esophagus and the stomach, along with the part of the upper stomach just below it, moves upward. The paraesophageal types, in which the junction stays in place while the dome of the stomach rises alongside the esophagus, account for only about 5% of cases. In all three of these types the stomach is the only organ that moves up, which covers more than 99% of hernias overall. Another organ moving up with the stomach, such as the colon, the small intestine, the spleen, or the omentum (the fatty membrane inside the abdomen), happens only in type IV, a small subset of the paraesophageal hernias that accounts for no more than 1% of cases. In all of its types, this hernia remains an internal hernia inside the chest, so it does not show up as a bulge or as a lump you can feel under the skin.
Advancing age: Age is one of the strongest risk factors, because connective tissue and muscle lose their elasticity over the years and the hiatus widens. That is why the condition becomes noticeably more common after the age of fifty. Many of these hernias, though, cause no symptoms at all and are found by chance during an endoscopy or a scan done for another reason.
Excess weight and raised pressure inside the abdomen: The best established of these factors, and the one that can actually be changed, is excess weight, especially fat around the waist, because of the constant upward pressure it puts on the top of the stomach. Other things that repeatedly raise pressure inside the abdomen are considered likely contributors: pregnancy, the chronic cough that comes with chronic respiratory disease, repeated vomiting, chronic constipation and the straining that goes with it, fluid collecting inside the abdomen, and severe repeated straining when lifting heavy weights. These last factors are linked to the development of the hernia as a scientifically probable association rather than as a confirmed cause. One point is worth clearing up: because this hernia sits inside the chest, the widely repeated advice about correct lifting technique does not apply to it. That advice is about abdominal wall hernia, an entirely different condition, and there is no evidence that lifting technique protects the esophageal hiatus.
Weak connective tissue and family history: Hiatal hernia has been seen to run in families, and both disordered formation of collagen fibers and inherited diseases that affect connective tissue have been linked to a higher chance of developing it. That is because keeping the stomach in place below the diaphragm depends on the strength of these supporting tissues, not on muscle alone.
Structural and congenital factors: Some people are born with a hiatus that is wider than usual, or with an esophagus that is shorter than normal, so the hernia appears at a younger age. Severe deformities of the spine, such as scoliosis and kyphosis, may also go along with a widened opening. It is worth noting that the congenital diaphragmatic hernia diagnosed in newborns is a completely separate condition from the hiatal hernia described here, and the two should not be confused.
Previous surgery on the esophagus and upper stomach: Some operations can weaken the way the esophagus is held at the hiatus. The clearest example is previous antireflux surgery, after which the hernia can still come back; others include the operation that divides the esophageal muscle to treat achalasia, and surgery on the upper part of the stomach and the area of the hiatus. Severe injuries, such as road accidents and falls from a height, can tear the diaphragm itself, which is a separate emergency condition and is not a hiatal hernia.
Factors that make symptoms worse but do not cause the hernia: Smoking, large rich or spicy meals, eating right before bed, lying down after eating, carbonated drinks, and tight clothing and belts around the waist; caffeinated drinks may play a part in some people as well. These relax the lower esophageal sphincter, the muscular valve between the esophagus and the stomach, or increase acid reflux, so they make heartburn and other symptoms worse in someone who already has the hernia, but they are not a proven cause of the hernia itself. Smoking has an extra, indirect effect through the chronic cough it causes, which raises pressure inside the abdomen. Changing these habits eases symptoms but does not make the hernia go away, and deciding on the type and severity of the hernia remains the doctor's job, after a clinical examination and the appropriate tests.

Types of Hiatal Hernia and Which Ones Are Dangerous

Not every hiatal hernia is the same. Doctors sort them into four types, and the type is what decides whether the condition needs nothing more than medication and follow-up, or whether it needs surgery.

Type I: The Sliding Hernia

This is by far the most common type, making up more than 90% of cases, with some references putting the figure as high as 95%. In it, it is the junction between the esophagus and the stomach that slides up toward the chest through the hiatus, and it may slip back into place on its own.

Main symptoms: heartburn and acid reflux, because the natural valve that keeps acid from coming back up becomes weak.
Usually treated with medication and lifestyle changes: small, frequent meals, weight loss, not lying down straight after eating, raising the head of the bed at night, along with acid-reducing medication chosen by your doctor. Surgery is only considered if symptoms stay troublesome despite regular treatment.
Strangulation of the hernia, or loss of its blood supply, is very rare in this type.

Types II, III and IV: The Paraesophageal Hernia

These three form one group and account for only about 5% of cases, but they are the ones that carry the real danger.

Type II: the fundus, the dome of the stomach, pushes up alongside the esophagus while the junction between the esophagus and the stomach stays in place below. This is the rarest type.
Type III (mixed): a combination of types I and II, in which the junction and part of the stomach move up together. In practice it is the most common of the paraesophageal hernias.
Type IV: another organ moves up into the chest along with the stomach, such as the colon, the small intestine, the spleen, or the omentum. This is the most dangerous type and the most prone to becoming acutely trapped (incarcerated).

Why are these types dangerous? Because when a large part of the stomach ends up sitting high in the chest, it can twist on itself (gastric volvulus). The blood supply to the twisted part is cut off and strangulation follows, and it can go on to erosion or perforation. That is a surgical emergency that needs immediate intervention.

For this reason, a paraesophageal hernia is repaired surgically once symptoms appear: the opening in the diaphragm is repaired and the fundus of the stomach is wrapped around the esophagus. This is different from a small sliding hernia, which is controlled with medication.

An Important Point to Reassure You

Most hiatal hernias cause no symptoms at all. Fewer than 10% of people who have one actually feel symptoms, and the rest are found by chance during an endoscopy or a scan done for another reason. In other words, seeing the phrase "hiatal hernia" in your imaging report does not mean you need an operation.

As for shortness of breath: it is not a common symptom of a small sliding hernia. When it does happen, it is usually tied to a large hernia, especially the paraesophageal type, because a large part of the stomach takes up room inside the chest and presses on the lung and the diaphragm, leaving the lung less room to expand. Shortness of breath together with a large hernia is therefore a sign that calls for surgical assessment, and it should not be ignored.

How a Hiatal Hernia Is Diagnosed

Why a physical exam is not enough: This is an internal hernia — part of the stomach pushes up through the diaphragmatic hiatus into the chest — so there is no bulge to see under the skin and no lump that can be felt by hand. Diagnosis therefore depends on tests that look at the esophagus and stomach from the inside, or that show them on X-ray and scan images. Not every patient needs every test; they are chosen according to the symptoms and according to whether surgery is being considered.
Medical history and physical examination: Your doctor will ask about burning in the chest, food or a sour taste coming back up into your mouth, difficulty swallowing, and a burning feeling in the upper stomach after eating or when you lie down — a feeling caused by acid reflux. You will also be asked about feeling full early in a meal, shortness of breath after large meals, and repeated coughing or hoarseness, since these are symptoms that may accompany the paraesophageal type. The examination itself is normal in most cases, and its role is to rule out other causes of the symptoms, not to prove that the hernia is there.
Upper endoscopy: In practice, this is the test that most often finds this hernia. You fast for several hours beforehand and are often given light sedation, then a flexible tube with a camera on the end is passed down to view the esophagus and stomach directly. It detects the hernia and, at the same time, assesses inflammation of the esophagus (esophagitis), ulcers, narrowing (stricture), and the changes that chronic reflux produces in the lining of the esophagus, and a biopsy can be taken through it when needed. Many cases are picked up during an endoscopy that was arranged for reflux symptoms in the first place. That said, the size of the hernia as judged at endoscopy can differ from one examination to the next, so endoscopy is not relied on by itself when surgery is being planned.
Barium study (barium swallow): This is the clearest test for showing the anatomy of the hernia. You swallow a contrast liquid, and a series of images is then taken that shows part of the stomach rising into the chest. It establishes the type of hernia, its size, and where the stomach sits within it — information that is essential when surgical treatment is being considered. It is more accurate than endoscopy for assessing a large hernia and the paraesophageal type. No single test is enough on its own to diagnose this condition; each one fills in what the others cannot show.
CT scan: A CT scan is not ordered routinely, only in selected situations. These include a large hernia, a hernia that has come back after previous surgery, or a suspicion that the stomach has become trapped (incarcerated) or has twisted inside the chest, which is an emergency. A hernia is also often discovered by chance on a CT scan that was done for a completely different reason.
Blood tests: A complete blood count and a test of iron stores may be ordered. A large hernia can be accompanied by slow, chronic bleeding from ulcers that form where the stomach is pinched at the diaphragmatic hiatus. That shows up as iron-deficiency anemia with no visible bleeding, and this alone may be what draws attention to the condition.
Esophageal manometry (measuring the pressure in the esophagus): This is not the test used to diagnose the hernia, although it may show that the lower esophageal sphincter has separated from the level of the diaphragm. It is usually done before surgery to assess how well the esophagus moves food along, to rule out conditions that affect the contraction of the esophageal muscles and cause symptoms resembling reflux, and to help choose the most suitable surgical technique.
24-hour esophageal pH monitoring: This records how often acid rises from the stomach into the esophagus and how long it stays there over a full day, and it matches those reflux episodes with the symptoms reported during the recording. Its role is to confirm reflux and show how severe it is when the symptoms are unclear, when they do not improve with medication, or before surgery — not to prove that the hernia is present.
Tests that are not relied on for this diagnosis: A plain chest X-ray may show a large hernia purely by chance, and it is not suitable for ruling one out, because the sliding type, which is the most common form, usually does not show up on it. Abdominal ultrasound, likewise, is not an established test for diagnosing this hernia in adults.
What it means when the hernia appears in the report: The sliding type is the most common by a wide margin, accounting for more than ninety percent of cases, and many of these cause no symptoms at all and are found by chance. The paraesophageal types make up no more than about five percent of cases, and they are the only ones that carry the possibility of the stomach becoming trapped or twisting inside the chest. The size of the hernia is also not necessarily proportional to how severe the symptoms are. And the presence of the hernia in an endoscopy or radiology report does not by itself mean that surgery is needed; treatment is decided by the symptoms and by whether or not complications are present.
Signs that call for urgent testing, not delay: increasing difficulty swallowing or food getting stuck, pain on swallowing, repeated vomiting, unintended weight loss, or anemia with no clear explanation. These signs must not be attributed to the hernia before an urgent upper endoscopy is done, because they may point to a complication or to another condition that needs a rapid diagnosis. Vomiting blood or material that looks like coffee grounds, or passing black, tarry stools, means going to the emergency department right away.

Complications of a Hiatal Hernia

First, some reassurance: most hiatal hernias cause no complications at all. Many people have a small hernia and feel nothing; it is discovered by chance on an endoscopy or an imaging study done for another reason. Complications tend to appear when the hernia is large, or when acid reflux goes untreated for years.

One point is worth clearing up before the details. A hiatal hernia is an internal hernia: part of the stomach rises toward the chest through the esophageal opening in the diaphragm. That is why it does not cause a visible bulge under the skin, a lump you can feel with your hand, or pain low in the abdomen. Those are signs of an inguinal hernia or an abdominal wall hernia, which is a completely different condition.

Possible complications:

Esophagitis: acid rising from the stomach irritates the lining of the esophagus, causing a burning feeling in the middle of the chest and pain or soreness when you swallow.
Esophageal stricture: inflammation that repeats over a long period can leave scarring that narrows the esophagus, so food feels as though it stops in the chest and takes a while to go down.
Barrett's esophagus: long-term reflux changes the type of cells lining the esophagus. It needs follow-up by endoscopy, because it slightly raises the risk of esophageal cancer.
Stomach ulcers and erosions, and anemia: with a large hernia, linear erosions can form in the stomach at the level of the diaphragm (Cameron ulcers). They bleed slightly but continuously, in amounts too small to see in the stool, so iron-deficiency anemia develops, along with fatigue, pale skin and shortness of breath on the slightest effort.
A trapped or twisted stomach: in the paraesophageal type, part of the stomach can become trapped above the diaphragm or twist on itself, causing obstruction and reducing the blood supply to the stomach. This is a surgical emergency.

When to go to the emergency room right away: sudden, severe pain in the middle of the chest or the upper abdomen; repeated retching that brings nothing up; being unable to swallow even water; vomit that is dark brown or contains blood; or severe shortness of breath.

Treatment of a Hiatal Hernia at Town Hospital

There is more than one way to treat a hiatal hernia at Town Hospital, and the right one for you depends on your general health and on your doctor's assessment. These are the main options.

Medication

Your doctor may prescribe medicines that ease the symptoms of acid reflux and heartburn. These include proton pump inhibitors and H2 blockers (H2-receptor antagonists). These medicines relieve heartburn and reflux, but they do not close the opening in the diaphragm and do not repair the hernia itself, so most people stay on treatment for their symptoms with regular medical follow-up.

Surgery

If symptoms are severe, or they do not improve with medication, surgery may be the appropriate option. The operation closes the widened opening in the diaphragm and wraps the upper part of the stomach around the esophagus, a repair known as fundoplication. It is usually done laparoscopically.

Diet and lifestyle measures

Everyday changes can bring real improvement: not eating large meals before bedtime, staying away from foods that make reflux worse, and avoiding smoking and alcohol.

Laparoscopic (keyhole) surgery

In some cases the repair can be done laparoscopically. A thin tube carrying a camera is passed through small openings in the abdomen, so the surgeon can work precisely with the least possible surgical intervention.

It is important to have a specialized medical team assess your condition and recommend the treatment option that suits you best.

Drawing on up-to-date techniques and current medical knowledge, Town Hospital provides comprehensive care for people living with a chronic hiatal hernia. With early diagnosis and a treatment plan built around the individual, patients can improve their quality of life and live in better health.

Frequently Asked Questions

Is a hiatal hernia dangerous?

In most cases, no. More than 90% of hiatal hernias are the sliding type and most of them are small, so many people live with one without symptoms and only find out by chance during an endoscopy or an X-ray. Seeing the words "hiatal hernia" in a radiology report does not mean you need an operation. In a hiatal hernia, part of the stomach rides up toward the chest, so there is no bulge you can see or feel with your hand and no lower abdominal pain; what you feel instead is heartburn, reflux, pain behind the breastbone, and difficulty swallowing. The risk sits with a smaller group of cases. Reflux left untreated for years can inflame and narrow the esophagus, or lead to Barrett's esophagus, which needs follow-up. A large hernia can, in a small percentage of cases, cause erosions that lead to iron-deficiency anemia. And the paraesophageal type, about 5% of cases, is the one in which the stomach can become trapped or twist. Do not assume that shortness of breath or chest pain is coming from the hernia, because cardiac symptoms can look like reflux. Go to the emergency department immediately if you have chest pressure with shortness of breath, pain spreading into the arm, sudden severe pain with retching that brings nothing up, or an inability to swallow even water.

Does a hiatal hernia need surgery?

In most cases, no. Most hiatal hernias cause no symptoms, are found by chance, and need no treatment at all. The sliding type, about 90 to 95% of cases, is usually controlled without surgery: small meals, weight loss, staying upright for two to three hours after eating, and raising the head of the bed, along with whatever acid-reducing medicine your doctor decides on. Surgery comes into the picture if your symptoms stay troublesome despite regular treatment, if complications appear such as severe esophagitis, narrowing of the esophagus, or iron-deficiency anemia, or if the hernia is the paraesophageal type and is causing symptoms. It is that type specifically, not the sliding type, that carries the risk of the stomach becoming trapped or twisting. When there are no symptoms, the 2024 recommendations of the Society of American Gastrointestinal and Endoscopic Surgeons lean conditionally toward repair, and favor follow-up if you are older or in poor general health, so the decision is an individual one. One important point: if you have shortness of breath or chest pain, do not assume it comes from the hernia, because you need an evaluation to rule out cardiac or respiratory causes. And if you develop sudden severe pain in the chest or upper abdomen with retching that brings nothing up, or you cannot swallow, that is an emergency and you should go to the hospital immediately.

What are the types of hiatal hernia and how do they differ?

First, some reassurance: most hiatal hernias cause no symptoms at all. The condition means that part of your stomach rides up toward the chest; it is not a swelling in your abdomen and not a lump you can see. There are four types. The first is the sliding hernia, about 90% of cases; its predominant symptoms are heartburn and reflux, and treatment is usually lifestyle changes plus medicines that reduce stomach acid. The second, third, and fourth are grouped together as paraesophageal hernias, about 5% of cases, and these are the ones that carry the risk: part of the stomach rides up alongside the esophagus, and in the fourth type another organ moves up with it, such as the colon or the spleen. This kind can become trapped or twist so that its blood supply is cut off, and it can cause slow, ongoing bleeding and iron-deficiency anemia. When this type causes symptoms it needs a surgical assessment; when it causes no symptoms, doctors are still divided between follow-up and surgery. A large hernia can take up space in the chest and cause shortness of breath, but that is only said once cardiac and pulmonary causes have been ruled out: if you have shortness of breath or chest pain, the heart and lungs come first. And if you get sudden severe pain in the chest or upper abdomen, retching that brings nothing up, or an inability to swallow, go to the emergency department immediately.

Does a hiatal hernia cause palpitations and shortness of breath?

Shortness of breath is possible; palpitations have only a weak link to it, and the hernia is not the first explanation to consider. A hiatal hernia means that part of the stomach has moved up into the chest through the opening in the diaphragm, not a swelling in the abdomen. Most cases cause no symptoms at all, and only about 10% of people, or fewer, feel anything. The sliding type alone accounts for about 90% of cases, and when it is small it rarely causes shortness of breath. Shortness of breath makes sense with a large paraesophageal hernia, less than 5% of cases and the type that can become trapped or twist; it happens when the stomach presses on the lung, and it tends to get worse after large meals. As for palpitations after eating, there is an old explanation called Roemheld syndrome, but the evidence behind it is limited to individual case reports and it is disputed. That is why both symptoms are assessed as a heart or lung problem first, with an examination and an ECG. Difficulty breathing when you lie flat on your back, or waking up choking, points toward the heart rather than the hernia. And if the shortness of breath is sudden or severe, or comes with chest pain, fainting, or a cold sweat, or if you have sudden severe pain in the upper abdomen with retching that brings nothing up or difficulty swallowing, you need to be seen immediately at the nearest hospital.

How do I know if I have a hiatal hernia?

A small hernia often causes no symptoms and is found by chance. When symptoms do appear, they can include heartburn and acid reflux, a sour taste at the back of the throat, difficulty swallowing, and pain or pressure in the upper abdomen or the middle of the chest, along with burping and bloating. A firm diagnosis comes from an endoscopy or a barium X-ray ordered by a doctor.

Is it possible to live with a hiatal hernia?

Yes. Most small hernias can be managed by controlling the symptoms: small meals, not eating before bed, raising the head of your bed for sleep, losing weight, and acid-reducing medicines. Large hernias, or ones with complications, may need surgery, and that is a decision your doctor makes.

How long does treatment for a hiatal hernia take?

There is no set duration, because medication does not treat the hernia itself. In a hiatal hernia, part of the stomach has risen toward the chest through the esophageal opening; acid-reducing medicines relieve the heartburn and the reflux, but the opening stays as it is, so most people stay on treatment for the symptoms over a long period, with regular follow-up. It also differs by type. The sliding type is the most common, more than 90% of cases, and most small ones cause no symptoms at all and need nothing beyond follow-up and lifestyle changes. The paraesophageal type, especially when it is large, is the one where surgical repair is discussed, because part of the stomach can become trapped, twisted, or have its blood supply cut off. Surgery is the only thing that actually repairs the hernia. It is usually done laparoscopically, with repair of the opening and a fundoplication; recovery takes a few weeks on a soft diet, and the hernia can come back afterward, so follow-up is still necessary. One important point: do not assume that chest pain or sudden shortness of breath is coming from the hernia, because it may be cardiac or pulmonary and need emergency care right away, and the same goes for repeated vomiting, difficulty swallowing, severe pain after eating, or black stools.

What is the difference between acid reflux and a hiatal hernia?

Acid reflux is stomach acid coming back up into the esophagus, and it can happen on its own. A hiatal hernia is part of the stomach pushing upward through the opening in the diaphragm, and it is one cause of reflux, not the only one. The symptoms overlap, so telling the two apart takes a medical assessment with endoscopy or imaging.

What does diaphragm pain feel like?

It is usually a burning or a feeling of pressure in the upper abdomen or behind the breastbone, and it can get worse after eating, when you bend over, or when you lie down. Sudden severe chest pain with difficulty breathing is different: that calls for going to the emergency department immediately to rule out a heart problem.