Hiatal Hernia & Reflux
Hiatal Hernia and Acid Reflux Are Related — But They Are Not the Same Thing
If you have heartburn, pressure, belching, regurgitation, or symptoms that seem worse after eating or lying down, it can be difficult to know whether you are dealing with acid reflux, a hiatal hernia, or both. A hiatal hernia is an anatomical condition in which part of the stomach moves upward through the opening in the diaphragm. Acid reflux describes stomach contents flowing backward into the esophagus.
The two conditions frequently overlap because a hiatal hernia can interfere with the normal barrier that helps keep stomach contents from moving upward. However, you can have acid reflux without a hiatal hernia, and you can have a hiatal hernia without noticeable reflux symptoms.
At a Glance
Hiatal Hernia vs Acid Reflux: Quick Comparison
| Feature | Hiatal Hernia | Acid Reflux |
|---|---|---|
| What it is | Part of the stomach moves upward through the diaphragm. | Stomach contents travel backward into the esophagus. |
| Main issue | Anatomical change. | Backward flow of stomach contents. |
| Can occur without symptoms? | Yes. Many hiatal hernias cause few or no symptoms. | Reflux is defined by the reflux event, although symptom severity varies considerably. |
| Common symptoms | May include reflux, pressure, fullness, belching, or swallowing symptoms when symptomatic. | Heartburn, regurgitation, sour taste, throat irritation, and sometimes cough. |
| Can one contribute to the other? | Yes. A hiatal hernia can make reflux more likely in some people. | Reflux does not necessarily mean a hiatal hernia is present. |
| How it may be evaluated | Medical history plus testing such as imaging or endoscopy when appropriate. | Often based on symptoms initially, with additional testing when symptoms persist or the diagnosis is uncertain. |
Understanding Reflux
What Is Acid Reflux?
Acid reflux occurs when material from the stomach travels backward into the esophagus. The esophagus is not designed to tolerate repeated exposure to acidic stomach contents, so frequent reflux can cause irritation and symptoms.
The lower esophageal sphincter, located near the junction of the esophagus and stomach, normally helps limit this backward movement. Reflux can occur when this barrier relaxes at inappropriate times or does not function effectively.
Common Acid Reflux Symptoms
- Heartburn or burning behind the breastbone
- Sour or acidic taste in the mouth
- Regurgitation of food or fluid
- Symptoms that worsen after eating
- Symptoms that worsen when bending over or lying down
- Frequent belching
- Throat irritation or hoarseness
- Chronic cough in some people
Understanding the Anatomy
What Is a Hiatal Hernia?
The esophagus passes through an opening in the diaphragm called the esophageal hiatus before connecting with the stomach. A hiatal hernia occurs when a portion of the stomach moves upward through this opening.
The most common type is a sliding hiatal hernia, in which the junction between the esophagus and stomach moves upward above the diaphragm.
Another, less common type is a paraesophageal hernia, in which part of the stomach moves beside the esophagus. Larger or paraesophageal hernias can require different medical considerations than a typical small sliding hernia.
Possible Symptoms of a Hiatal Hernia
- Heartburn or reflux
- Regurgitation
- Belching
- Upper abdominal or lower chest pressure
- Feeling unusually full after eating
- Difficulty or discomfort with swallowing
- Symptoms that worsen after larger meals
Many small hiatal hernias are discovered incidentally and may cause no symptoms at all.
How They Overlap
How Are Hiatal Hernia and Acid Reflux Connected?
The diaphragm and lower esophageal sphincter normally work together to help limit reflux. When part of the stomach moves above the diaphragm, the relationship between these structures can change.
In some people, that change can reduce the effectiveness of the anti-reflux barrier and make it easier for stomach contents to move upward.
The diaphragm and lower esophageal sphincter help create a barrier between the stomach and esophagus.
Part of the stomach moves upward through the diaphragm.
The altered anatomy may make backward flow of stomach contents more likely.
This does not mean every person with a hiatal hernia will develop GERD, nor does it mean everyone with GERD has a hiatal hernia.
Symptom Overlap
Symptoms That Can Occur With Either Condition
Symptoms alone do not always make it obvious whether reflux is occurring by itself or whether a hiatal hernia is also present.
This overlap is one reason persistent symptoms may require medical evaluation rather than relying only on symptoms to determine the cause.
Symptom Patterns
What Symptoms Are More Typical of Acid Reflux?
Although there is significant overlap, certain patterns are commonly associated with reflux.
Burning Sensation
Classic heartburn often produces a burning feeling that rises behind the breastbone.
Sour Taste or Regurgitation
Stomach contents may travel high enough to create a sour taste or noticeable regurgitation.
Worse After Meals
Symptoms may become more noticeable after larger, fatty, or late-night meals.
Worse Lying Down
Gravity no longer helps keep stomach contents down when a person reclines.
When Symptoms Deserve a Closer Look
When Symptoms May Suggest More Than Simple Reflux
No individual symptom proves that a hiatal hernia is present. However, certain symptoms warrant more careful medical assessment, especially when they are persistent or worsening.
- Difficulty swallowing
- Pain with swallowing
- Persistent pressure or discomfort in the chest or upper abdomen
- Feeling very full after relatively small meals
- Frequent vomiting
- Unexplained weight loss
- Evidence of gastrointestinal bleeding
- Persistent symptoms despite appropriate reflux treatment
Can You Have Acid Reflux Without a Hiatal Hernia?
Yes. Reflux can occur for many reasons even when the stomach remains in its normal position below the diaphragm.
Factors that may contribute include changes in lower esophageal sphincter function, increased pressure within the abdomen, meal size and timing, certain foods or beverages, body position, medications, pregnancy, and other individual factors.
Can You Have a Hiatal Hernia Without Acid Reflux?
Yes. Many people have a small hiatal hernia without developing significant reflux or other symptoms.
A hiatal hernia may be discovered during an imaging study or endoscopy performed for an unrelated reason.
Medical Evaluation
How Are Persistent Reflux or Hiatal Hernia Symptoms Evaluated?
Evaluation usually begins with the symptom history, including when symptoms occur, what makes them better or worse, and whether swallowing or other gastrointestinal symptoms are present.
Depending on the clinical situation, a physician may recommend additional testing.
Allows direct examination of the esophagus and stomach and can help identify inflammation or other abnormalities.
Imaging can help demonstrate the anatomy of the esophagus, stomach, and a hiatal hernia.
Measures reflux events and acid exposure in the esophagus when additional confirmation is needed.
Measures pressure and coordination of the muscles involved in swallowing and esophageal function.
Symptom Management
What May Help With Reflux Symptoms?
Management depends on the severity and cause of symptoms. Some people improve with changes in eating patterns and body position, while others require medication or additional medical treatment.
- Avoid lying down immediately after eating
- Consider smaller meals if large meals trigger symptoms
- Identify foods or beverages that consistently worsen symptoms
- Avoid eating close to bedtime when nighttime reflux is a problem
- Discuss persistent symptoms with a qualified healthcare professional
- Use reflux medications only as directed by a healthcare professional or product instructions
When to Seek Medical Care
Do Not Assume Every Chest or Upper-Abdominal Symptom Is Reflux
Chest discomfort can have gastrointestinal, musculoskeletal, cardiac, pulmonary, and other causes. New, severe, or unexplained symptoms should not automatically be attributed to reflux or a hiatal hernia.
Seek prompt medical evaluation for symptoms such as:
- New or severe chest pain
- Chest pain associated with shortness of breath, sweating, dizziness, or exertion
- Vomiting blood
- Black or tarry stools
- Progressively worsening difficulty swallowing
- Persistent vomiting
- Unexplained weight loss
- Severe or rapidly worsening abdominal pain
Frequently Asked Questions
Hiatal Hernia vs Acid Reflux FAQs
Is a hiatal hernia the same thing as GERD?
No. A hiatal hernia is an anatomical condition. GERD is a condition involving troublesome or recurring reflux. A hiatal hernia may contribute to GERD, but they are not the same diagnosis.
Does everyone with a hiatal hernia have acid reflux?
No. Some people with a hiatal hernia have no reflux symptoms at all.
Does acid reflux mean I probably have a hiatal hernia?
Not necessarily. Reflux is common and can occur without a hiatal hernia.
Can a hiatal hernia make reflux worse?
It can. In some people, altered anatomy at the diaphragm and lower esophageal sphincter makes reflux more likely.
Can a hiatal hernia cause trouble swallowing?
Swallowing symptoms can occur with hiatal hernia, reflux-related inflammation, structural problems, or other conditions. Persistent difficulty swallowing should be medically evaluated.
Can a hiatal hernia cause chest pressure?
Some people report pressure or discomfort in the chest or upper abdomen. Because chest symptoms can also have more serious causes, new or unexplained chest discomfort should be appropriately evaluated.
How do doctors know whether a hiatal hernia is present?
A hiatal hernia may be identified through tests such as upper endoscopy or imaging of the upper gastrointestinal tract, depending on the clinical situation.
Final Thought
Acid reflux and hiatal hernia are often discussed together because they can occur at the same time. The simplest distinction is that acid reflux describes what stomach contents are doing, while a hiatal hernia describes where part of the stomach is positioned.
If reflux is persistent, swallowing becomes difficult, or symptoms are unusual or worsening, medical evaluation can help determine whether reflux, a hiatal hernia, or another condition is responsible.
For additional patient information, see the National Institute of Diabetes and Digestive and Kidney Diseases and Mayo Clinic .
