Acid reflux is often brushed off as a lifestyle issue—too much spicy food, late-night meals, or stress. While these triggers do play a role, many people continue to suffer despite making dietary and lifestyle changes.
This leads to an important question: Is something structural going wrong inside the body? One frequently overlooked culprit is a hiatal hernia, a condition that can silently fuel persistent acid reflux and gastroesophageal reflux disease (GERD). Understanding the connection between the two can help you seek more effective, long-term relief, shares Dr Amita Jain, who is one of the most experienced general and laparoscopic surgeons in Delhi and India.
What Is a Hiatal Hernia?
A hiatal hernia occurs when a portion of the stomach pushes upward through the hiatus, a small opening in the diaphragm through which the oesophagus passes before connecting to the stomach. The diaphragm normally acts as a supportive muscle, helping the lower oesophageal sphincter (LES) stay tight and prevent stomach acid from flowing backwards. When part of the stomach slips above this muscle, that natural barrier is weakened, says Dr Amita Jain, a leading hernia surgeon and specialist for hernia treatments in Delhi.
Hiatal hernias are surprisingly common, especially in people over 50, and many individuals may have one without knowing it. However, when symptoms appear, acid reflux is often the most noticeable and troublesome.
Types of Hiatal Hernia Explained
- Sliding Hiatal Hernia – This is the most common type. The junction where the oesophagus meets the stomach slides up into the chest, especially during swallowing or straining. Because the LES is displaced, it becomes less effective at keeping acid in the stomach, leading to frequent reflux symptoms.
- Paraesophageal (Rolling) Hiatal Hernia – Less common but more serious, this occurs when part of the stomach pushes up beside the oesophagus while the LES stays in place. Although reflux may or may not be present, this type can cause complications like reduced blood flow to the stomach and often requires surgical attention.
How a Hiatal Hernia Triggers Acid Reflux?
To understand the link, it helps to know how acid reflux develops. Normally, the LES opens to allow food into the stomach and then closes tightly. In a hiatal hernia, the stomach’s abnormal position interferes with this mechanism in several ways:
- Weakened LES pressure, allowing acid to escape into the oesophagus
- Loss of diaphragmatic support, which normally reinforces the LES
- Increased acid exposure, especially when lying down or bending forward
As a result, stomach acid can repeatedly flow upward, causing symptoms such as heartburn, chest discomfort, sour taste in the mouth, chronic cough, bloating, and difficulty swallowing.
Is a Hiatal Hernia Always the Real Cause?
While a hiatal hernia can significantly worsen acid reflux, it is not always the sole cause. Many people experience reflux due to obesity, pregnancy, smoking, certain medications, or poor eating habits without having a hernia. Conversely, some individuals with a hiatal hernia may have no symptoms at all.
The key difference lies in severity and persistence. If acid reflux is frequent, does not respond well to medications like antacids or proton pump inhibitors, or keeps returning after lifestyle changes, a hiatal hernia may be playing a central role.
Diagnosis and Management
Hiatal hernias are typically diagnosed through endoscopy, barium swallow X-rays, or imaging studies. Treatment depends on symptom severity:
Lifestyle changes: eating smaller meals, avoiding late dinners, weight management, and elevating the head while sleeping
Medications: acid suppressors to reduce irritation of the esophagus
Surgery: reserved for severe cases where reflux is uncontrolled or complications develop
A hiatal hernia may not be the cause of every case of acid reflux, but it is often a hidden driver behind chronic, stubborn symptoms. If reflux keeps disrupting your quality of life despite usual remedies, it’s worth looking beyond food choices and considering an underlying anatomical issue. Identifying and addressing a hiatal hernia can be the missing piece in finally gaining lasting relief from acid reflux.
Dr Amita Jain is one of India’s most distinguished and experienced female surgeons, known for her unmatched expertise in general and laparoscopic surgery. With over 29 years of surgical excellence, Dr Amita Jain has built a reputation for precision, compassionate care, and advanced surgical techniques.
Dr Amita Jain has successfully performed a wide range of complex general surgeries, including both open and minimally invasive procedures, with a strong focus on trauma care, onco-surgical techniques, and reconstructive surgeries. Her areas of specialisation include (including Gallbladder stone removal, appendix removal, hernia repair surgery, piles and fissure surgeries). She was the Professor of Surgery at the Army College of Medical Sciences and Base Hospital, Delhi Cantt. In 1994, she was commissioned asa Surgeon under the United Nations Mission in Congo. From 2020 to 2022, she worked with Bansals Hospital. Currently, Dr Amita Jain is the Senior General and Laparoscopic Surgeon at Rainbow Children Hospitals (Malviya Nagar, Delhi), Artemis Lite: Multi-Speciality Care Hospital (New Friends Colony, New Delhi) and at Rosewalk – Luxury Maternity Hospital in Delhi (Panchsheel Park, Delhi)
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