Hiatal hernia: symptoms, treatment and which doctor to see
What a hiatus hernia is, why it causes acidity and heartburn, how it is found, when lifestyle changes and medicines are enough, and when surgery helps.
What a hiatal hernia is
The diaphragm is the dome-shaped sheet of muscle that separates the chest from the abdomen. The food pipe (oesophagus) passes through a small opening in it, called the hiatus, to join the stomach. In a hiatal hernia — also called a hiatus hernia — part of the stomach pushes up through this opening into the chest.
The diaphragm normally helps keep acid in the stomach. When part of the stomach slides above it, that barrier weakens, and acid can flow back into the food pipe more easily. This is why a hiatal hernia and acid reflux (GERD) so often go together. Many people with a small hiatal hernia, though, have no symptoms at all and only find out when they have a scan or endoscopy for another reason.
Types
- Sliding hiatal hernia — by far the most common. The junction of the food pipe and stomach slides up into the chest, often moving up and down. Usually small and mainly causes reflux.
- Paraoesophageal hiatal hernia — less common. Part of the stomach squeezes up beside the food pipe. These can enlarge over time and, rarely, the trapped stomach can twist or lose its blood supply, which is an emergency.
Symptoms
When a hiatal hernia causes symptoms, they are mostly those of acid reflux:
- Heartburn — a burning feeling behind the breastbone, often after meals or when lying down; many people in India call this acidity or gas
- Regurgitation of sour or bitter fluid or food into the throat or mouth
- Frequent belching, bloating and feeling full quickly
- Chest pain or discomfort
- Difficulty swallowing, or a feeling that food is sticking
- A long-standing cough, hoarse voice or sore throat, especially in the morning
Larger hernias may cause breathlessness after meals because they press on the lungs, and slow bleeding from the stomach lining can lead to anaemia and tiredness.
Chest pain should never simply be put down to gas or a hernia. Pain from the heart can feel very similar, particularly in people with diabetes, high blood pressure or a family history of heart disease. If chest pain is new, severe, comes with sweating, breathlessness or pain spreading to the arm, jaw or back, treat it as a possible heart attack and call 112 or 108 straight away.
Causes and risk factors
The exact cause is often not clear. A hiatal hernia usually develops when the opening in the diaphragm widens and the tissues holding the stomach in place weaken. It is more common with:
- Increasing age
- Being overweight, especially around the waist
- Repeated pressure inside the abdomen — chronic cough, straining on the toilet, heavy lifting, or vomiting
- Pregnancy
- Smoking
- Previous surgery or injury in the area, and, in some people, a larger opening present from birth
How it is diagnosed
Many hiatal hernias are found by chance. When symptoms suggest one, or reflux is not settling with treatment, the doctor may arrange:
- Upper GI endoscopy — a thin camera passed through the mouth, usually with sedation or a throat spray, shows the hernia and any inflammation, ulcers or changes in the food pipe lining, and allows a biopsy
- Barium swallow — X-ray pictures taken while you drink a chalky liquid, showing the shape and size of the hernia
- Oesophageal manometry — measures the pressure and movement of the food pipe muscles, usually before surgery
- pH monitoring — records how often acid comes up into the food pipe over a day or more
Endoscopy is particularly important for people with warning signs: difficulty swallowing, weight loss, vomiting, black stools, anaemia, or new symptoms in later life.
Treatment
A hiatal hernia that causes no symptoms usually needs no treatment. When it does, the aim is to control reflux and protect the food pipe.
Lifestyle changes
- Eat smaller meals, and avoid lying down or sleeping for about three hours after eating — keep dinner early and light
- Raise the head end of the bed with blocks or a wedge; extra pillows alone tend to bend the waist and do not help as much
- Lose weight if you are overweight; even modest weight loss often eases symptoms
- Stop smoking, and cut down on alcohol
- Notice what sets off your symptoms — common culprits are fried and very spicy food, tea and coffee, chocolate, citrus and fizzy drinks
- Avoid tight belts and clothing around the waist, and bending or lifting heavy weights soon after meals
Medicines
Acid-reducing medicines are the mainstay. Antacids give quick, short-lived relief. H2 blockers and proton pump inhibitors reduce the amount of acid the stomach makes and allow inflammation in the food pipe to heal. Your doctor will advise which to use and for how long. Proton pump inhibitors are easy to buy from pharmacies, but long-term use should be reviewed with a doctor rather than continued indefinitely on your own.
Surgery
Surgery is considered when symptoms continue despite medicines, when a person does not want lifelong medication, when there are complications such as severe inflammation, narrowing or bleeding, or for large paraoesophageal hernias. The operation, usually done by keyhole (laparoscopic) surgery, pulls the stomach back into the abdomen, tightens the opening in the diaphragm and often wraps the top of the stomach around the lower food pipe to strengthen the valve — a procedure called fundoplication. Your surgeon will explain the benefits and possible side effects, such as temporary difficulty swallowing or bloating.
When to see a doctor, and when it is an emergency
See a doctor if you have heartburn or acidity more than a couple of times a week, need antacids most days, have difficulty swallowing, unexplained weight loss, persistent vomiting, black stools or anaemia.
Call 112 or 108, or go to the nearest emergency department, if you have sudden severe chest or upper abdominal pain, chest pain with sweating or breathlessness, vomiting blood or material that looks like coffee grounds, or you retch repeatedly but cannot vomit or swallow anything. These can be signs of a heart attack, bleeding, or a trapped hernia.
Which doctor to see
A general physician can treat mild reflux. A gastroenterologist investigates persistent or troublesome symptoms and performs endoscopy. A GI surgeon or general surgeon assesses whether an operation is needed. If you have long-standing acidity, it may also be worth reading about indigestion and peptic ulcer, which cause similar symptoms.
You can find gastroenterologists in Bengaluru or GI surgeons in Bengaluru on The Doctor Index, each with a registration you can check.
Common questions
Questions people ask
- Is a hiatal hernia dangerous?
- Most hiatal hernias are small sliding hernias that cause reflux or no symptoms and are not dangerous. Large paraoesophageal hernias can rarely become trapped or twisted, which is an emergency. Long-term untreated reflux can also damage the food pipe, so troublesome symptoms deserve medical review.
- Can a hiatal hernia go away on its own?
- A hiatal hernia does not usually close by itself. However, symptoms often improve a great deal with weight loss, smaller and earlier meals, raising the head of the bed and acid-reducing medicines, and many people never need surgery.
- Can exercise make a hiatal hernia worse?
- Regular exercise and weight loss are generally helpful. Heavy lifting, intense abdominal exercises or exercising on a full stomach can push up symptoms in some people. Exercise a couple of hours after eating and ask your doctor which activities suit you.
- Is a hiatal hernia the same as other hernias?
- No. Most hernias, such as groin or umbilical hernias, show as a bulge through the abdominal wall. A hiatal hernia is internal, through the diaphragm, and cannot be seen or felt from outside. It is usually found on endoscopy or a scan.
This condition is usually assessed by a gastroenterologist. Every profile shows the doctor’s registration and what has been checked.
Gastroenterologists in Bangalore
A few gastroenterologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Hiatal Hernia; ask the clinic whether the doctor sees it.
Related conditions
- Celiac Disease
- Constipation
- Crohn's Disease
- Diarrhea
- Diverticulosis and Diverticulitis
- Foodborne Illness
- Gallstones
- Gastroenteritis
All gastroenterology conditions →
Practical reading
All postsSources
- MedlinePlus, National Library of Medicine — Hiatal Hernia
- Government of India — Emergency Response Support System (112)
- MedlinePlus, National Library of Medicine — Hiatal Hernia — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Hiatal hernia: symptoms, treatment and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-1158.