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Could Your Heartburn Really Be a Hiatal Hernia?

Spicy foods may give you heartburn, dairy could make you gassy, or maybe it’s bread that makes you bloated. We’ve all learned what foods upset our stomachs, and we’ve even found the willpower to avoid those foods … sometimes. But if you are experiencing regular chest pain and stomach issues, then you may have a hiatal hernia.

Many hiatal hernias are ignored for months, even years, and assumed to be recurring cases of acid reflux or heartburn. To help distinguish between these symptoms and those from hiatal hernias, we spoke with Edward Charles, MD, a general surgeon at Banner Health Center plus in Glendale, Arizona.

What is a hiatal hernia?

A hiatal hernia occurs when the upper part of your stomach pushes through an opening in your diaphragm into the area where your esophagus is found. Small hernias are common and you won’t often have any noticeable symptoms. The larger the herniated portion of the stomach becomes, the more uncomfortable you’ll be. Hiatal hernias can be large enough to hold undigested food and stomach acid, which can damage your esophagus over time.

Symptoms of hiatal hernia

“The symptoms for most hiatal hernias are very similar to more familiar issues like acid reflux and heartburn. In fact, hiatal hernias can lead to gastroesophageal reflux disease (GERD),” said Dr. Charles. He listed the following symptoms, including:

  • Burning pain in the chest
  • Bitter or sour taste
  • The feeling of fluid coming back up the esophagus
  • Dysphagia (trouble swallowing)
  • Abdominal discomfort
  • Throat irritation
  • Belching or hiccupping
  • Regurgitation
  • Bad breath

Types of hiatal hernias

There are two types of hiatal hernias: a sliding hiatal hernia and paraoesophageal hernia.

Sliding hiatal hernias can move as you eat and swallow, which means that symptoms will be more severe as the herniated portion of the stomach bulges further through your diaphragm. This is the most common type of hiatal hernia by far, accounting for 95% of all cases.

Paraesophageal hernias are different in that the stomach protrudes through the diaphragm and sits next to the esophagus and does not slide up and down. As the portion above the diaphragm gets larger, this type of hernia gets more dangerous. In rare cases, the esophagus can become compressed or even cut off the blood flow to the stomach. While not all of these complications are medical emergencies, some could become life-threatening.

Diagnosing a hiatal hernia

Identifying the type of hernia you have is an important step to finding a solution. In general, hiatal hernias are diagnosed in people who are getting tests for GERD, heartburn, chest pain or abdominal pain. To get a proper diagnosis, your doctor may recommend a chest X-ray, an X-ray with a barium swallow or an upper endoscopy.


Dr. Charles explained that “most hiatal hernias are too small to cause worrisome symptoms. But for those who seem to have symptoms regularly to the point of distraction from regular eating habits and daily life, diagnosis and treatment are recommended.” Over-the-counter acid reflux medications, including proton pump inhibitors (PPIs), are a great starting point. Additionally, your doctor will recommend adjustments to your diet to avoid tomato-based ingredients or other ingredients that can upset your stomach. Dr. Charles also said obesity, late-night snacking, smoking and alcohol can contribute to—or aggravate— the symptoms of a hiatal hernia. Raising the head of your bed six inches can help relieve nighttime symptoms.

“It's rare that a hiatal hernia would require surgery,” commented Dr. Charles. “This becomes a possibility in those who no longer have relief from medications and lifestyle alterations or if the size of the hiatal hernia increases over time.”

Looking for more answers?

Do you have heartburn or acid reflux? To talk with a health care provider about your symptoms and your potential risk for a hiatal hernia, visit bannerhealth.com.

Learn more about conditions like GERD and hiatal hernias by reading these related articles: