Hiatal Hernia: Why It Causes Heartburn

A hiatal hernia causes heartburn by pushing part of your stomach through the diaphragm into your chest cavity, which disrupts normal digestion and weakens the barrier that prevents stomach acid from flowing back into your esophagus. Research shows that 95% of people with gastroesophageal reflux disease (GERD) also have a hiatal hernia, making this one of the most common causes of chronic heartburn.

When the stomach bulges upward through the diaphragm opening, it interferes with proper food movement and reduces the pressure that normally keeps acid where it belongs. The result is acid reflux and the burning chest sensation known as heartburn, especially after meals or when lying down.

Many people with small hiatal hernias have no symptoms at all. However, larger hernias are linked to more frequent heartburn and acid regurgitation. Here’s what causes this connection, the symptoms to watch for, and treatments that can provide relief.

How Does a Hiatal Hernia Trigger Heartburn?

A hiatal hernia is often connected to gastrointestinal issues like gastroesophageal reflux disease (GERD), commonly presenting with heartburn and regurgitation symptoms. According to the National Institute of Diabetes and Digestive and Kidney Diseases, understanding this connection is essential for effective treatment.

GERD develops when stomach contents, including digestive acids, repeatedly flow backward into the esophagus, the muscular tube connecting your mouth to your stomach. This backward flow of acidic stomach contents is known as acid reflux.

Research from 2021 examining 728 GERD patients found that 95.4% also had hiatal hernias, demonstrating a strong correlation between these conditions. The National Library of Medicine provides detailed clinical information about this relationship.

Individuals with hiatal hernias face elevated GERD risk because their stomach bulges into the chest cavity, interfering with proper food movement. Additionally, a hiatal hernia compromises the diaphragm’s ability to apply adequate pressure on the esophagus, which normally helps prevent acid reflux.

Heartburn ranks among the most prevalent GERD symptoms, occurring when refluxed acid creates a burning feeling in the chest. It’s also the most frequently reported complaint among hiatal hernia patients. Those with acid reflux typically experience heartburn following meals or while lying down.

That said, many individuals with hernias, particularly smaller ones, may remain symptom-free.

Earlier research from 2014 involving 75 hiatal hernia patients using self-assessment questionnaires revealed that larger hernias were associated with increased heartburn and acid regurgitation compared to smaller ones.

Additional Hiatal Hernia Symptoms

Beyond heartburn, watch for these symptoms:

• Chest discomfort
• Difficulty swallowing
• Belching and bloating sensations
• Persistent cough
• Unpleasant breath odor

The Mayo Clinic notes that these symptoms can vary significantly in severity from person to person.

Home Remedies for Hiatal Hernia-Related Heartburn

Heartburn can be both disruptive and painful. Consider these home-based approaches for relief.

Licorice Root Supplements

A 2017 observational study indicates that supplements or herbal preparations containing licorice root may ease heartburn symptoms. However, moderate your intake to avoid potential complications like elevated blood pressure and depleted potassium levels.

Gum Chewing

Surprisingly, chewing gum might offer heartburn relief. The chewing action increases saliva production, which can help dilute and clear stomach acid from your esophagus.

Baking Soda

Sodium bicarbonate, or baking soda, has alkaline properties. Some people use it as a natural antacid to address stomach acidity symptoms, including heartburn. Consult your doctor before trying this approach to prevent excessive reduction of stomach acid or electrolyte imbalances.

Eliminate Trigger Foods and Substances

Certain items can provoke acid reflux and heartburn:

• Alcoholic beverages
• Coffee and caffeinated drinks
• Tomatoes and tomato-based products
• Tobacco products
• Spicy and high-fat foods

These items may boost stomach acid production or weaken the lower esophageal sphincter (LES), the valve between your esophagus and stomach that prevents stomach contents from backing up. Healthline offers additional dietary guidance for managing symptoms.

Medical Treatment Options for Hiatal Hernia-Induced Heartburn

Your physician may recommend several treatment approaches for heartburn and hernia-related discomfort.

Acid-Neutralizing or Acid-Reducing Medications

Options include over-the-counter antacids for occasional reflux episodes. H2 receptor blockers, which decrease stomach acid production, may also be prescribed. Examples include famotidine (Pepcid AC) and cimetidine (Tagamet HB). Hopkins Medicine provides comprehensive information about medication options.

Acid-Blocking Medications

Proton pump inhibitors (PPIs) prevent stomach acid production and allow the esophagus to recover from damage caused by ongoing acid exposure. Your doctor might suggest an OTC version or prescribe a stronger formulation.

Surgical Intervention

When a hiatal hernia causes severe heartburn or other serious complications, surgery may be recommended. Surgical procedures can include:

• Reconstructing the esophageal sphincter through fundoplication surgery
• Reducing the size of the diaphragm opening
• Repositioning the stomach from the chest back into the abdominal cavity where it belongs

Harvard Health explains that surgical intervention is often the most effective long-term solution for severe cases.

When Should You Seek Medical Attention?

If you’ve received a hiatal hernia diagnosis and experience persistent symptoms like heartburn, bloating, or difficulty swallowing, it’s important to contact your healthcare provider if these symptoms continue or become more severe. Additionally, inform your doctor immediately if you notice unintended weight loss, nausea, or vomiting.

Warning Signs That Require Prompt Evaluation

Don’t ignore these symptoms, as they may indicate your condition is worsening or causing complications:

• Chronic chest pain, especially after eating
• Regurgitation of food or sour liquid
• Feeling full quickly after small meals
• Shortness of breath
• Esophageal spasms
• Signs of anemia, such as fatigue or weakness, which may result from ulcers caused by the hernia

In rare but serious cases, certain types of hiatal hernias can cause the stomach to become trapped and twist within the hernia. This is a medical emergency requiring immediate attention. The NHS emphasizes the importance of recognizing these warning signs.

Why Specialized Care Matters

While many people manage mild hiatal hernia symptoms with lifestyle modifications and medications, persistent or severe symptoms often require evaluation by a specialist who focuses specifically on reflux-related conditions. Related digestive issues like achalasia and gastroparesis may also require specialized treatment.

At Tampa Bay Reflux Center, Dr. Grandhige has dedicated over a decade to developing individualized treatment strategies for patients struggling with hiatal hernias and GERD. As a nationally recognized expert in diagnosing and surgically treating reflux conditions, Dr. Grandhige offers cutting-edge treatment options including robotic fundoplications, the LINX procedure, and the TIF/EsophyX procedure.

Approximately 90% of patients with gastroesophageal reflux disease also have a hiatal hernia. Because these conditions are so closely connected, seeking care from the best hiatal hernia doctors in Tampa ensures you receive comprehensive evaluation and treatment tailored to your unique symptoms and anatomy. WebMD recommends working with experienced specialists for optimal outcomes.

Take the Next Step Toward Relief

If home remedies and over-the-counter medications aren’t providing adequate relief, or if your symptoms are interfering with your daily life, it may be time to explore more advanced treatment options. The only definitive treatment for a symptomatic hiatal hernia is surgical repair, and modern minimally invasive techniques can offer long-lasting relief with faster recovery times. For more information, visit our reflux center blog or explore MedlinePlus hiatal hernia resources.

Ready to eliminate your reflux symptoms? Contact us today to schedule an appointment with Dr. Grandhige and discover which treatment approach is right for you. You can also learn about our incisionless weight loss procedures and other advanced treatments available at our center.

Conclusion

Hiatal hernias and heartburn share a strong connection, with research showing that the vast majority of GERD patients also have a hiatal hernia. While many people with small hiatal hernias experience no symptoms, larger hernias can significantly disrupt normal digestive function and lead to chronic heartburn, regurgitation, and other uncomfortable symptoms. The good news is that effective treatments exist, ranging from simple lifestyle modifications and over-the-counter medications to advanced surgical procedures for more severe cases. If you’re experiencing persistent heartburn or other symptoms, working with a healthcare provider can help you find the right treatment approach and prevent potential complications. Early diagnosis and proper management are essential for preventing long-term esophageal damage. Taking action now can bring lasting relief and improve your quality of life.

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