How a hiatal hernia causes reflux, and when it needs repair
A hiatal hernia is a widened or weakened opening in the diaphragm that lets the top of the stomach slip up into the chest. That breaks the reflux barrier. The diaphragm and the lower esophageal sphincter normally keep reflux in check together, as the NIH’s overview of GERD explains, so when the hernia pulls them out of line, acid and other stomach contents move up more easily. Almost every reflux patient has a hiatal hernia, even a small one that an endoscopy cannot see.
Dr. Grandhige recommends repair when a hernia is larger than 3 centimeters, because at that size it almost always drives reflux mechanically and tends to grow over time. He also repairs smaller hernias when they come with strong reflux symptoms like regurgitation, or with complications such as severe esophagitis or Barrett’s esophagus. Large hernias carry a small risk of a serious problem called gastric volvulus, where the stomach twists, which is another reason he does not leave them to grow.
Medication changes the acid but not the anatomy. That is why so many people stay on daily pills for years and still have breakthrough symptoms, and why repairing the hernia is often what finally controls GERD when the hernia is the cause.
Testing comes first, always
Dr. Grandhige does not recommend surgery based on symptoms. He proves reflux first with objective testing, because symptoms alone are unreliable and several conditions imitate reflux. Each test answers a different question.
An upper endoscopy shows damage, such as inflammation or Barrett’s esophagus, but it does not measure reflux itself, and a normal endoscopy does not rule reflux out. pH monitoring measures how often reflux happens, how long each episode lasts, and whether it lines up with your symptoms. He calls this the gold standard for diagnosing reflux. Esophageal manometry measures how well the esophagus squeezes and coordinates, which is what tells him whether a full or partial wrap is safe, and it catches motility disorders like achalasia that reflux surgery would make worse. A barium swallow shows what actually happens when you swallow.
Skipping these tests is how the wrong surgery gets done. To make the visit useful, you can email prior records to info@tampareflux.com before you come, so Dr. Grandhige reviews your endoscopy, testing, imaging, and other doctors’ notes first.
The four anti-reflux procedures, and who each one fits
There is no single best reflux operation. The right one depends on your anatomy, how well your esophagus works, and your goals. Dr. Grandhige performs all four, so the procedure is chosen for your body rather than for what one surgeon can do. His numbers are public on the practice website: more than 600 fundoplications, more than 600 LINX procedures, and more than 200 TIF procedures.
Silent reflux (LPR) is easy to miss, and needs different testing
Silent reflux, or LPR, is reflux that reaches the throat and voice box, and it often causes no heartburn at all. Standard reflux testing usually misses it, because that testing looks lower down in the esophagus. The throat is far more sensitive than the esophagus, so even a small amount of reflux reaching it can cause real symptoms.
The common signs are chronic throat clearing, hoarseness, a cough that will not settle, a lump-in-the-throat feeling, and postnasal drip. Many of these patients see ENT, pulmonology, and allergy first, and are told it is allergies or asthma, or that their endoscopy is normal.
Dr. Grandhige uses a custom 24-hour dual-channel pH-impedance probe that measures reflux at two levels, including up near the throat, above the upper esophageal sphincter. It also measures non-acid reflux like bile and pepsin, which standard acid testing cannot see. Most centers do not do this, because it is technically demanding and insurance reimburses it poorly. Without this testing, LPR surgery is often quoted at around a 50 percent chance of helping. With it, he selects the right patients and improvement rises to roughly 80 percent. So he operates on fewer LPR patients, on the ones far more likely to get better.
He is also honest about the timeline. LPR symptoms often take four to six months to improve, unlike typical heartburn, which can settle within days. You can read more about silent reflux (LPR) and how it is diagnosed.

Getting seen from Clearwater
Clearwater patients are seen at the practice in South Tampa, usually within two weeks and always within four. The office is at 1315 South Howard Avenue, Suite 101, in a yellow brick building next to Sally O’Neill’s Pizza, with parking behind the restaurant. Hours are 9 a.m. to 6 p.m., Monday through Friday, and the phone is 813.922.2920.
Send prior records to info@tampareflux.com before your visit, including any endoscopy, pH testing, manometry, or imaging, so Dr. Grandhige reviews everything first. If you already have testing, one consultation is often enough. If you need testing, the plan is usually two visits about four weeks apart, and most patients go from first visit to surgery within four to eight weeks. Most reflux and hiatal hernia procedures are covered by insurance once testing documents the problem, and the office verifies your coverage before anything is scheduled. You can learn more about the practice and how Dr. Grandhige works before you book.
FAQS
About the author: Gopal Grandhige, MD
Dr. Gopal Grandhige is a board-certified general surgeon and the founder and medical director of Tampa Bay Reflux Institute, which he opened in 2022 after running Tampa Bay Reflux Center from 2009. He has focused only on foregut surgery, meaning the esophagus, diaphragm, and stomach, since 2009. He earned his medical degree at the University of Michigan, completed his general surgery residency at Yale New Haven Hospital, and finished fellowships there in foregut and minimally invasive surgery and in burn and critical care. He is a Fellow of the American College of Surgeons, a member of SAGES, and a founding member of the American Foregut Society. He holds privileges at St. Joseph’s Main, St. Joseph’s South, HCA Brandon, and HCA South Tampa hospitals, and performs his surgeries at HCA South Tampa. You can confirm his board certification through the American Board of Surgery.
Get answers about your hiatal hernia
If reflux or a hiatal hernia is affecting your sleep, your voice, or your daily life, the next step is a clear diagnosis, not another year of guessing. Dr. Grandhige will tell you whether reflux is the cause, which of your symptoms he expects to improve, and whether surgery makes sense for you. If it does not, he will say so.
An endoscopy cannot tell you if you have reflux. It can only tell you if you have complications of GERD.
If you are unhappy with your reflux symptoms, come in and we can discuss testing and treatments that can accurately diagnose your problem.
#reflux #gerd #hiatalhernia #gastroparesis #linx
CALL US AT 813-922-2920
www.tampareflux.com
If you have a hiatal hernia and fit one of these categories, you should know your options.
Dr. Grandhige is an expert in his field and performs 200 of these surgeries a year. He is the only surgeon in the Tampa Bay Area who offers all surgical options - LINX, Fundoplications, TIF and will be one of 20 surgeons in America introducing the latest procedure RefluxStop in 2026.
We accept most insurances but will verify yours before you come in. These procedures are considered medically necessary and covered by your insurance. You can expect to pay your in-network deductibles and nothing else.
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What causes reflux ?
1. Weak lower esophageal sphincter
2. Hiatal hernia
3. Flattening of the Angle of His
4. Poor esophageal motility
5. Gastroparesis (slow stomach)
NOT increased acid production
Don’t let GERD get in the way of living your life. Request your appointment with us today on the link below.
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https://tampareflux.com/contact-us/
Anyone can be victim to GERD and though weight loss can help reduce GERD symptoms. Many athletes with high impact workouts may continue to have these symptoms. This may be a symptom of a hiatal hernia or other issue. We are more then happy to assist you in finding your solution, just click the link below.
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Heartburn may seem like an annoyance. But if you find yourself having symptoms on a daily basis, it may be time to to talk to Dr. Grandhige as it could be a symptom of something worse.
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If you are tired of avoiding your favorite foods or taking daily medications, we can help.
We are the Tampa experts in reflux ! With years of experience and thousands of patients treated successfully, we offer all FDA approved anti-reflux procedures.
Call 813-922-2920 to schedule your appointment
All major insurances accepted.
Not all patients need surgical intervention. Many patients are living a heartburn free life with their PPIs. However 40% of patients taking PPIs are not getting the relief they need. If you are one of those, you have options! Come in and find out more.
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