Written by: WWH Surgeon Dr. Wendy Liu

Have you ever experienced heartburn, regurgitation, or trouble swallowing and wondered what might be causing it? These are some classic symptoms of gastroesophageal reflux disease (GERD). While many factors can contribute to GERD, one lesser-known cause is something called a hiatal hernia.

To understand a hiatal hernia, it helps to know a bit about how your body is built. Your diaphragm is a large muscle that helps you breathe and separates your chest cavity from your abdomen. There’s a small opening in the diaphragm called the hiatus, which allows your esophagus—the tube that carries food from your mouth to your stomach—to pass through and connect to your stomach. A hiatal hernia occurs when part of your stomach pushes up through this opening and into your chest cavity. Normally, your stomach should stay below the diaphragm, but if it slides upward, that’s when a hernia forms.

There are several factors that may contribute to the development of a hiatal hernia. The basis of this comes down to a connective tissue disease. Some people may simply have weaker tissue compared to others. As we get older, there is a natural weakening of the diaphragm with time.  Pregnancy, obesity, or the need to perform frequent tasks that require heavy lifting or straining, will often place more pressure on the diaphragm causing the development of a hiatal hernia. The presence of a hiatal hernia is quite intimately associated with symptoms of GERD. As the stomach protrudes up above the diaphragm, the natural valve by the lower esophageal sphincter is disrupted leading to an ineffective barrier to prevent acid from refluxing up to the lower esophagus.

Hiatal hernias can be diagnosed with many different types of treatment. The most reliable and accurate way to identify a hiatal hernia is an upper endoscopy or esophagogastroduodenoscopy (EGD). This allows the physician to assess the lining of the esophagus, stomach, and the first portion of the small intestines called the duodenum and take biopsies of anything concerning. This test is often paired with a pH study called the Bravo pH capsule, which helps to detect the amount of acid refluxing up to the esophagus and give a correlation of acid to symptoms.

There are people who may have hiatal hernias but have no GERD symptoms. These often do NOT have to be surgically repaired. However, those who have GERD as well as a hiatal hernia may consider surgical treatment. We used to think of GERD as a symptom we treat forever with medications. However, these medications do not stop acid from refluxing; they simply make it so that we don’t feel the effects of the acid. Over the past few years, there has been progressively a shift in thought in treating GERD as a structural problem related to the hiatal hernia. If we can return the anatomy back to normal, perhaps we can treat the root cause of GERD and avoid lifelong medications.

Similarly to an abdominal wall hernia, a hiatal hernia will never regress over time. Lifestyle modifications such as avoiding trigger foods, avoiding alcohol, smoking, and excessive weight gain may help slow its progression.  The good news is that most people with a hiatal hernia can live normal, healthy lives, especially with the right management. Simple changes in diet and lifestyle often make a big difference. It’s important to follow up with your healthcare provider if you ever experience severe chest pain, trouble swallowing, vomiting blood, or black stools, seek medical attention right away, these could be signs of complication.

A hiatal hernia might sound like a big deal, but it’s more common and less frightening than it seems. By understanding what it is and how it affects your body, you can take steps to manage it and feel your best. As always, if you’re dealing with ongoing digestive discomfort, don’t ignore it—talk to your doctor and get the care you need.

At Western Wisconsin Health, we believe that empowering individuals with knowledge is a vital step toward lasting wellness. Understanding conditions like hiatal hernias and GERD allows you to make informed decisions about your health and take proactive steps toward feeling your best. Whether it’s through lifestyle guidance, advanced diagnostics, or surgical care, our team is here to support you every step of the way. We’re building a healthier tomorrow, together; one patient, one conversation, one solution at a time.

If you would like to learn more information about our treatment options for GERD, please visit Western Wisconsin Health and schedule an appointment to see Dr. Wendy Liu, or Dr. Peter Dahlberg.