To understand how a hiatus hernia happens, it helps to know more about the structures inside your body.
You have a sheet of muscle, called your diaphragm, which separates your chest from your abdomen (tummy). Usually, your stomach sits completely below your diaphragm.
When you swallow your food, it passes down a tube called your oesophagus to your stomach. Your oesophagus passes through an opening in your diaphragm, called the hiatus. A hiatus hernia usually develops when part of your stomach slides back up through this opening and into your chest.
There are two types of hiatus hernia: a sliding hiatus hernia and a rolling hiatus hernia. Around eight out of 10 people with a hiatus hernia have the sliding type. This is when both your stomach, and the place where your oesophagus and stomach meet (known as the gastro-oesophageal junction), slide upwards into your chest.
A rolling hiatus hernia is where just part of your stomach pushes up into the chest. It ends up alongside your oesophagus. This type is more of a problem and you’re likely to need an operation if you have this.
Sometimes a hiatus hernia doesn’t cause any symptoms.
However, a sliding hiatus hernia can cause a problem called gastro-oesophageal reflux disease (GORD). This is when acid in your stomach rises back up into your oesophagus. Sometimes it’s called by a shorter name – acid reflux.
The main symptom of GORD is heartburn, which causes a warm or burning sensation in your chest and throat.
Other symptoms of hiatus hernia and GORD include:
- feeling or being sick
- coughing or wheezing, especially at night – this is caused by breathing in the acid that has come up from your stomach
- your mouth filling with saliva
- finding it difficult or painful to swallow
Not everyone with a hiatus hernia has GORD, but they often go together.
Your GP may be able to recommend treatments to help your symptoms of heartburn without any need for tests or a formal diagnosis.
If your symptoms are more severe, or you’ve over the age of 55, your GP may refer you to a gastroenterologist (a doctor who specialises in the digestive system) for tests.
The gastroenterologist may suggest you have a barium meal X-ray. In this test, you swallow a substance that helps to show up your digestive system on an X-ray.
Another test your specialist may advise is an endoscopy (also called a gastroscopy). This test is done using a tube with a camera on the end, called an endoscope. The endoscope is passed through your mouth and down into your stomach. Your doctor can see images of the inside of your oesophagus and stomach on a screen. He or she can also take a biopsy (a tissue sample) at the same time.
A hiatus hernia is sometimes discovered by chance when you have a test for something else. This is because a hiatus hernia doesn't always cause symptoms.
The treatment you’re offered will depend on how severe your symptoms are and how much they’re bothering you.
There’s a lot you can do to ease the symptoms of a hiatus hernia, and prevent further problems.
- If you need to lose weight, this can make a big difference to your symptoms. You might like to try following our practical weight loss advice.
- Giving up smoking is a sensible step. Try our tools to help you stop smoking for good.
- Cutting down on alcohol will also help.
- Instead of eating three big meals, aim for several smaller ones throughout the day.
- Try not to eat just before bedtime.
- Raise the head of your bed if heartburn bothers you at night.
- If you notice that some foods and drinks make your heartburn worse, try cutting them out. Some of these might include coffee, chocolate, and fatty foods. There’s more detailed advice in the section on food and drinks below.
There are numerous indigestion medicines available that can ease the symptoms of heartburn. You can buy many of these from your pharmacist without a prescription. But your doctor can advise which treatment may be best for you, depending on your symptoms.
Your doctor may recommend some of the following medicines.
- Antacids – these work by neutralising the acid produced in your stomach.
- Alginates (for example, Gaviscon) – these form a raft that floats on top of your food and stomach acid, making a barrier.
- Proton pump inhibitors (PPIs) – these work by reducing the amount of acid your stomach produces.
- H2 receptor antagonists – these also reduce the amount of acid produced by your stomach.
If other treatments haven’t worked and your symptoms are severe, your doctor may suggest an operation.
There are a number of different types of operation to repair a hiatus hernia. They all involve putting the top part of your stomach back into your abdomen and tightening the opening in your diaphragm.
Your surgeon may also strengthen the ring of muscles that stops acid and food coming up from your stomach and into your oesophagus. This procedure is called a fundoplication.
If you have a rolling hernia, your doctor may also recommend an operation to prevent it from becoming trapped (strangulated). You’ll need urgent surgery if you have a rolling hernia that does become strangulated.
Our guide to living with a hiatus hernia can help you understand what makes your symptoms better or worse and the treatment options available to you so you can manage your condition in a way that suits you.
It’s not clear exactly why some people develop a hiatus hernia. However, people who are obese (very overweight) are more likely to develop one. You’re also more likely to develop a hiatus hernia as you get older. This might be because the muscles in your diaphragm get weaker.
Hiatus hernia can also happen during pregnancy. The condition is more common in smokers.
Occasionally, a hiatus hernia can lead to more serious problems. Your oesophagus can become damaged by the acid from your stomach, and this can lead to ulcers. These ulcers can be painful when you swallow and they may bleed. As the ulcers heal, scars can develop, which may narrow your oesophagus. This can cause food to get stuck or to come back up.
If you have a hiatus hernia, you may have acid coming up from your stomach into your oesophagus. Over time, this can cause a condition called Barrett’s oesophagus. This is where the cells that line your oesophagus change and become abnormal. Eventually, these cells may become cancerous. If you have Barrett’s oesophagus, your doctor will monitor cells in your oesophagus to spot and then treat any changes quickly.
A rolling hiatus hernia can sometimes get trapped or pinched by the diaphragm, cutting off the blood supply. This is called a strangulated hernia and causes severe pain. If this happens, you’ll need an operation immediately.
FAQ: Obesity and hiatus hernia I am overweight and often get heartburn. Could I have a hiatus hernia?
People who are overweight are more likely to get heartburn and indigestion. They’re also more likely to develop a hiatus hernia.
The exact reasons for this link aren’t known. However, being overweight can increase the pressure inside your abdomen (tummy). This forces acid from your stomach up into your oesophagus, causing heartburn.
Heartburn is a common symptom of a hiatus hernia. Other symptoms include finding it difficult or painful to swallow, feeling sick or being sick, and coughing or wheezing. Contact your GP if you have any of these symptoms or if you think you might have a hiatus hernia.
Certain foods can make symptoms of hiatus hernia worse. The triggers are different for everyone, but you might find some of the following foods make your symptoms worse:
- spicy food
- fatty food
- alcoholic drinks
- drinks with caffeine
- citrus fruits and fruit drinks
Try to keep a record to see what foods trigger your symptoms. You can then try to avoid them in your diet.
Making changes to your lifestyle can help control the symptoms of heartburn. When it comes to diet, the evidence isn’t clear, but some foods might make your symptoms worse. The most important thing is that you keep following a healthy diet. You could try keeping a food diary. Then if you notice that some foods make your heartburn worse, try to avoid them.
Everyone is different, but some common problems after hiatus hernia surgery include difficulties in swallowing, and feeling full and uncomfortable, especially after eating.
As with any treatment, you’ll need to weigh up the possible benefits and risks of having surgery for hiatus hernia. Your doctor will help you to do this.
If a rolling hiatus hernia gets trapped (strangulated), you’ll need urgent surgery. Sometimes your doctor will advise you to have an operation to prevent this from happening.
Talk to your doctor about the risks of having or not having surgery to decide what’s best for you.
Some possible complications from surgery include:
- a bloated feeling, especially after you’ve eaten
- difficult or painful swallowing
Sometimes the benefits of the operation don’t last and it may need to be done again. If your symptoms come back after your operation, talk to your surgeon.
- Gastroenterology. Oxford handbook of clinical medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, 2014
- Hiatal hernia. BMJ Best Practice. bestpractice.bmj.com reviewed 21 September 2015
- Endoscopy. Cancer Research UK. www.cancerresearchuk.org, reviewed 22 April 2015
- Esophagus anatomy. Medscape. www.emedicine.medscape.com, published 20 July 2015
- Sands BE. Mount Sinai Expert Guides: Gastroenterology. 1st ed. Chichester: John Wiley & Sons, 2015: 101–10
- Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ 2014; 349:g6154.
- Barium X-ray. Cancer Research UK. www.cancerresearchuk.org, reviewed 12 April 2015
- Dyspepsia and gastro-oesophageal reflux disease: investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both (CG184). National Institute for Health and Care Excellence. 2014. www.nice.org.uk
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.evidence.nhs.uk/formulary/bnf/current, accessed 23 September 2015
- Bredenoord AJ, Pandolfino JE, Smout AJ. Gastro-oesophageal reflux disease. Lancet 2013; 381(9881): 1933–42.
- Hiatus hernia. PatientPlus. www.patient.info/patientplus, reviewed 28 February 2014
- Guidelines for the management of hiatal hernia. Society of American Gastrointestinal and Endoscopic Surgeons, 2013. www.sages.org
- Surgery. Oxford handbook of clinical medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, 2014
- Suspected cancer: recognition and referral. National Institute for Health and Care Excellence (NICE), June 2015. www.nice.org.uk
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form Ask us a question
Reviewed by Pippa Coulter, Specialist health editor, Bupa Health Content Team, December 2015.
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
Information StandardWe are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Meet the team
Head of health content and clinical engagement
- Dylan Merkett – Lead Editor – UK Customer
- Nick Ridgman – Lead Editor – UK Health and Care Services
- Natalie Heaton – Specialist Editor – User Experience
- Pippa Coulter – Specialist Editor – Content Library
- Alice Rossiter – Specialist Editor – Insights
- Laura Blanks – Specialist Editor – Quality
- Michelle Harrison – Editorial Assistant
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: firstname.lastname@example.org. Or you can write to us:
Health Content Team
15-19 Bloomsbury Way