The Common Digestive Issue Millions Don’t Know They Have

Health Points

• A hiatal hernia occurs when part of the stomach pushes through the diaphragm into the chest cavity, affecting up to 60% of adults by age 60
• Many people experience no symptoms, but others suffer from persistent heartburn, difficulty swallowing, and chest pain that mimics heart problems
• Lifestyle changes including weight management, smaller meals, and avoiding late-night eating can help control symptoms without surgery in most cases

For millions of Americans over 40, that persistent heartburn might signal something more than just indigestion. A hiatal hernia—a condition where part of the stomach pushes upward through the diaphragm—affects a surprising number of adults, yet many don’t realize they have it.

The diaphragm, the muscle separating your chest from your abdomen, contains a small opening called the hiatus where the esophagus passes through to connect with the stomach. When part of the stomach bulges through this opening, it creates what doctors call a hiatal hernia.

“The majority of hiatal hernias are discovered incidentally during tests for other conditions,” says Dr. Michael Thompson, a gastroenterologist at Johns Hopkins Medicine. “Many people live their entire lives without knowing they have one.”

There are two main types of hiatal hernias. A sliding hiatal hernia, the most common variety, occurs when the stomach and the section of the esophagus that joins it slide up into the chest through the hiatus. This type comes and goes, sliding up when you bend over or lie down.

The less common paraesophageal hernia happens when part of the stomach squeezes through the hiatus and sits beside the esophagus. While often symptom-free, this type carries more risk of complications because the stomach can become trapped or have its blood supply cut off.

Age plays a significant role in hiatal hernia development. Research shows that up to 60% of people over age 60 have some degree of hiatal hernia, though most remain unaware. The condition becomes more common as the muscles and tissues naturally weaken with age.

Being overweight or obese increases pressure on the abdomen, making hiatal hernias more likely. Pregnancy creates similar pressure, which explains why some women develop the condition during or after carrying a child. Chronic coughing, straining during bowel movements, and heavy lifting can also contribute to hernia formation.

“The symptoms, when they do occur, often mirror gastroesophageal reflux disease or GERD,” Dr. Thompson notes. “Patients typically experience heartburn, acid reflux, and sometimes difficulty swallowing.”

Some people with hiatal hernias experience chest pain that can be alarming enough to send them to the emergency room fearing a heart attack. The pain results from stomach acid backing up into the esophagus, creating a burning sensation behind the breastbone.

Other common symptoms include frequent burping, feeling unusually full after eating small amounts, and trouble swallowing both food and liquids. Some people notice they feel worse after eating large meals or lying down shortly after eating.

Diagnosis typically starts with imaging tests. A barium swallow study, where patients drink a chalky liquid that shows up on X-rays, can reveal the hernia’s presence and size. An upper endoscopy allows doctors to view the esophagus and stomach directly using a thin, flexible tube with a camera.

For those without symptoms, treatment usually isn’t necessary. When symptoms do occur, lifestyle modifications often provide relief. Eating smaller, more frequent meals instead of three large ones reduces pressure on the stomach.

Avoiding foods that trigger acid reflux—including chocolate, caffeine, alcohol, fatty foods, and acidic items like tomatoes and citrus—helps many people manage symptoms. Finishing meals at least three hours before bedtime gives the stomach time to empty.

Elevating the head of the bed by six to eight inches can prevent nighttime acid reflux without the neck strain that comes from piling up pillows. Maintaining a healthy weight reduces abdominal pressure that can worsen symptoms.

Over-the-counter antacids provide quick but temporary relief from heartburn. H2 blockers like famotidine reduce acid production for longer-lasting relief. For more severe cases, doctors may prescribe proton pump inhibitors, which block acid production more completely.

“Surgery becomes an option when medications and lifestyle changes don’t control symptoms, or when complications develop,” explains Dr. Thompson. “We also recommend surgery for paraesophageal hernias due to the risk of strangulation.”

The most common surgical procedure, called fundoplication, involves wrapping the upper part of the stomach around the lower esophagus to strengthen the barrier against acid reflux. Surgeons can often perform this laparoscopically, using small incisions that reduce recovery time.

Left untreated, severe hiatal hernias can lead to complications. Chronic acid reflux can damage the esophageal lining, leading to Barrett’s esophagus, a condition that increases cancer risk. The stomach can become trapped in the chest cavity, cutting off its blood supply in a medical emergency called strangulation.

Some people develop anemia from slow, chronic bleeding where the hernia passes through the diaphragm. The constant irritation can cause small areas of the stomach or esophagus to bleed, often without obvious symptoms until anemia develops.

For the vast majority of people with hiatal hernias, however, the prognosis remains excellent with proper management. Simple dietary changes and medication, when needed, keep symptoms under control and allow people to maintain their normal activities.

Anyone experiencing persistent heartburn, difficulty swallowing, or chest pain should consult a healthcare provider. While these symptoms might indicate a hiatal hernia, they can also signal other conditions requiring different treatment approaches.

Early diagnosis and appropriate management prevent complications and improve quality of life. With the right combination of lifestyle adjustments and medical care, people with hiatal hernias can find relief and avoid the more serious consequences of untreated symptoms.