A hiatal hernia can cause acid reflux, as it affects the muscles that prevent stomach acid from flowing back up the esophagus.

A hiatal hernia occurs when the stomach bulges through a gap in the diaphragm, allowing stomach acid to travel up toward the throat.

This article looks at the link between a hiatal hernia and acid reflux and the symptoms, diagnosis, and treatment.

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A hiatal hernia can cause acid reflux and is the main cause of gastroesophageal reflux disease (GERD).

The hiatus is the opening in the diaphragm, which allows the esophagus to pass through to reach the stomach. The esophagus is a tube running from the throat to the stomach that transports food and liquids.

A hiatal hernia occurs if the upper section of the stomach, or another internal organ, bulges through the hiatus.

This bulge affects the lower esophageal sphincter (LES). The LES helps prevent stomach acid from traveling back up the esophagus.

A hiatal hernia can stop the LES from closing completely, allowing stomach acid to flow back up the esophagus. This can cause heartburn and damage to the esophagus.

Read about GERD.

GERD is one of the key symptoms of a hiatal hernia. People may commonly experience heartburn and, sometimes, regurgitation.

Other symptoms of acid reflux may include:

Around 9% of people with a hiatal hernia may experience symptoms. A hiatal hernia may only cause symptoms if it is large.

To diagnose a hiatal hernia, doctors may carry out the following tests:

  • Endoscopy: Doctors insert an endoscope, which is a thin, flexible tube with a light and camera at one end, down the throat to examine the esophagus.
  • Manometry: During an esophageal manometry test, a doctor will insert a thin, flexible tube through the nose, down the esophagus, and into the stomach. Manometry records pressure in the esophagus and the function of muscle contractions and the LES.
  • pH monitoring: Experts consider pH monitoring the gold standard in diagnosing acid reflux. Doctors will insert a probe above the hiatus to measure levels of acid exposure.
  • Esophagogram: An esophagogram, or barium swallow test, is a live X-ray of the esophagus. The X-ray shows swallowing action while people take a barium solution, allowing a doctor to see how the esophagus functions.

The risk of developing a hiatal hernia increases with age. Around 55–60% of people over 50 may have a hiatal hernia.

As people get older, muscle weakness may affect stomach position during swallowing. This can prevent the top part of the stomach from returning to its usual position underneath the diaphragm.

The risk of developing a hiatal hernia is higher in females, possibly due to increased pressure in the abdomen during pregnancy.

Other risk factors for a hiatal hernia may include conditions that increase pressure in the abdomen, such as:

Genetics, trauma to the abdomen, or previous surgery may also play a part in hiatal hernia formation.

Read more about hiatal hernias.

To manage symptoms of a hiatal hernia, a doctor may prescribe proton pump inhibitors (PPIs).

PPIs reduce the amount of stomach acid the stomach produces and help heal damage to the esophagus. People can buy PPIs over the counter or with a prescription. PPIs are generally suitable for long-term treatment of GERD.

Other medications that may help treat symptoms of acid reflux include:

  • Antacids: People can buy antacids over the counter to treat mild symptoms. Antacids are unsuitable for long-term use or to treat severe symptoms without talking with a doctor first.
  • H2 blockers: H2 blockers are drugs that reduce stomach acid levels in the stomach. H2 blockers may also help heal damage to the esophagus. H2 blockers can be bought over the counter or with a prescription. If H2 blockers are ineffective, doctors may prescribe PPIs.

Learn more about acid reflux medications.

Lifestyle changes may help reduce acid reflux symptoms. These include:

  • losing excess weight and maintaining a moderate weight
  • quitting or avoiding smoking
  • placing extra pillows or a foam wedge underneath the head and upper back while sleeping to elevate the head by 6–8 inches

Altering dietary habits may also help reduce acid reflux symptoms. Certain foods and drinks may trigger or worsen GERD symptoms. These foods and drinks include:

  • citrus fruits, tomatoes, and other acidic foods
  • chocolate
  • alcohol
  • caffeine
  • high fat foods
  • spicy foods
  • mint

It may also help to eat at least 3 hours before lying down or going to sleep.

Read about foods to eat and avoid with GERD.

People may require surgery for a hiatal hernia if they have:

  • severe problems with the esophagus, such as an ulcer
  • an esophageal stricture, which is a narrowing of the esophagus
  • Barrett’s esophagus, a condition describing damage to the lower esophagus due to acid reflux, which can lead to cancer
  • persistent, long-term symptoms that do not improve or resolve with medication or lifestyle changes

Doctors may carry out a surgical procedure called fundoplication to repair a hiatal hernia. During this surgery, a surgeon will wrap the top section of the stomach, called the fundus, around the lower part of the esophagus.

A surgeon may carry out a fundoplication using minimally invasive surgery, called laparoscopy. A surgeon will make small incisions in the abdomen to carry out the procedure.

Fundoplication helps strengthen the LES to prevent acid reflux.

Read more about surgery for GERD.

Medications and lifestyle changes may help manage symptoms of acid reflux.

Surgery to treat a hiatal hernia may resolve acid reflux symptoms and treat heartburn within a few weeks of the procedure. This can allow people to stop taking heartburn medications. Symptoms may return years after surgery, though.

Research suggests that surgery results in a 90% reduction in symptoms 10 years after surgery.

A hiatal hernia can cause stomach acid to flow from the stomach back up the esophagus. People may experience symptoms, such as heartburn and regurgitation.

Treatments may include medications and lifestyle changes to manage acid reflux. In people with severe cases, doctors may recommend surgery to repair the hiatal hernia.