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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Heartburn and reflux from a hiatus hernia are assessed and treated by video; difficulty swallowing, weight loss or vomiting need tests in person.
- What it is: part of the stomach moves up through the opening in the diaphragm, the muscle between the chest and the tummy, into the chest.
- How common: very common with age: in US data, about 50% of people over 50, 60% over 60 and 70% over 70 have one, and many never have symptoms.
- Main symptoms: heartburn, acid reflux, bloating, bad breath, and sometimes difficulty swallowing.
- Emergency: call 112 for chest pressure spreading to the arm, neck or jaw, vomiting blood or material like coffee grounds, or black, tar-like poo.
Do not book a video appointment if you have chest pain or pressure that spreads to your arm, neck or jaw, are vomiting blood or material like coffee grounds, have black, tar-like poo, or have sudden severe pain in your chest or upper tummy and cannot keep anything down. Call 112 or go to an emergency department.
Can an online doctor treat a hiatus hernia?
Yes. A hiatus hernia does not need treatment unless it causes symptoms, and the symptoms it causes, mainly heartburn and acid reflux, can be assessed and treated by video: the doctor advises on lifestyle changes, recommends pharmacy medicines and may prescribe stronger ones. Difficulty swallowing, weight loss without trying, frequent vomiting or blood need tests in person, such as a camera test, and surgery is for the few people whose symptoms do not respond to other treatment.
How an online consultation helps with a hiatus hernia
- Reflux, or something else?: Chest pain and burning have other causes, including the heart, and the doctor checks for them first.
- Medicines that suit you: Antacids, alginates or a stronger acid-reducing medicine, chosen after checking your other medicines.
- Changes that make a difference: Meal size and timing, the right way to raise the bed, and which triggers to cut down.
- Tests when they are needed: Which symptoms mean a camera test, and when surgery is worth discussing.
What the doctor checks in an online hiatus hernia consultation
The doctor rules out the warning signs first, then looks at the pattern of your symptoms. The doctor asks about:
- Warning signs: chest pain spreading to the arm, neck or jaw, difficulty or pain swallowing, weight loss, frequent vomiting, blood in your sick, or black poo.
- Your symptoms: heartburn, reflux, bloating or a cough, how often they happen, and whether they are worse after meals, lying down or bending over.
- Triggers: food and drink, alcohol, smoking, late meals and stress.
- Medicines: anti-inflammatory painkillers such as ibuprofen, and the indigestion medicines you have tried.
- Your health: pregnancy, weight, earlier tests such as a camera test, and earlier operations.
Before the call, note what brings your symptoms on, which medicines you have tried and how well they worked.
What is a hiatus hernia?
A hiatus hernia is when part of the stomach moves up into the chest, through the opening in the diaphragm where the food pipe passes. It is very common in people over 50, many people have one without knowing, and it does not normally need treatment unless it causes problems. In US data, hiatus hernias affect about 20% of the general population, 50% of people over 50, 60% over 60 and 70% over 70.
Sliding and other types
The sliding type is by far the most common, accounting for 95% of hiatus hernias. Most people with a sliding hernia never feel it. The other types, called paraoesophageal hernias, are less common. Rarely, a hiatus hernia can get stuck or squeezed, blocking the stomach or cutting off its own blood supply, which is an emergency.
What are the symptoms of a hiatus hernia?
Many people with a hiatus hernia have no symptoms. When there are symptoms, they are the same as those of reflux, and are often worse after eating, when lying down and when bending over:
- heartburn: a painful burning feeling in the middle of the chest, often after eating
- acid reflux: bringing up small amounts of food or bitter-tasting fluid
- bad breath, bloating, and feeling or being sick
- a recurring cough or hiccups, or a hoarse voice
- difficulty or pain when swallowing
Larger hernias can also cause chest or upper tummy pain, feeling full soon after eating, shortness of breath, and, if there is bleeding, vomiting blood or black poo.
Where is hiatus hernia pain felt? Is it different in women?
In women and men alike, it is usually a burning feeling in the middle of the chest, behind the breastbone, or pain in the upper tummy, often after meals. Chest pain also has other causes, including the heart: chest pressure that spreads to the arm, neck or jaw needs 112, not a wait to see if it is reflux.
Can a hiatus hernia cause shortness of breath or a cough?
Yes. A large hiatus hernia can press on the lungs and cause shortness of breath, and reflux can cause a recurring cough or hiccups. Breathlessness and a cough also have other causes, so new symptoms need a doctor.
How long does a hiatus hernia flare-up last?
There is no set length. Symptoms tend to come after meals and when lying down or bending, and antacids or alginates ease them for a while. See a doctor if your symptoms have not gone after 3 weeks, come most days, or do not improve with pharmacy medicines.
What causes a hiatus hernia?
The exact cause is often not clear. A hiatus hernia happens when the muscle around the opening in the diaphragm weakens and lets the stomach bulge up. These make it more likely:
- being 50 or older, as the diaphragm changes with age
- being overweight
- pregnancy
- persistent pressure in the tummy from coughing, vomiting, straining on the toilet, exercise or heavy lifting
- an injury to the area, or certain types of surgery
- being born with a very large opening in the diaphragm
Is a hiatus hernia serious? Complications
Usually not. Most hiatus hernias are small and cause no problems. Long-term reflux and, rarely, a hernia that gets stuck can cause complications:
Swipe sideways to compare →
| Complication | What it is | Signs | What to do |
|---|---|---|---|
| Oesophagitis | Inflammation of the food pipe from acid | Heartburn, pain when swallowing | Acid-reducing medicine; tests if it does not settle |
| Narrowing (stricture) | Scarring narrows the food pipe | Food sticking, difficulty swallowing | Prompt tests in person |
| Barrett’s oesophagus | Long-term reflux changes the lining of the food pipe; it is considered precancerous | Often none | A camera test and monitoring |
| Bleeding | Bleeding from the inflamed lining | Vomiting blood, or black poo | Call 112 |
| A stuck hernia | The hernia is trapped and its blood supply is cut off | Severe chest or upper tummy pain, vomiting | Call 112 |
Will a hiatus hernia go away on its own?
No. Hiatus hernias do not go away, and they usually get worse over time. That does not mean you need treatment: many people never have symptoms, and in most of those who do, lifestyle changes and medicines control them.
What foods should you avoid with a hiatus hernia?
There is no single hiatus hernia diet. The common triggers are coffee, alcohol, chocolate, and greasy or spicy food, but they differ from person to person, so notice what brings on your symptoms and cut down on it. How and when you eat matters as much:
- Eat smaller, more frequent meals, and eat less fat: rich, fatty meals trigger more stomach acid.
- Finish eating 3 to 4 hours before you go to bed.
- Do not lie down or bend over straight after a meal.
How do you stop a hiatus hernia attack?
Sit or stand upright rather than lying down or bending, loosen tight clothing around your waist, and take an antacid or alginate from a pharmacy. Next time, eat a smaller meal earlier in the evening. Chest pain that spreads to the arm, neck or jaw needs 112.
Which hiatus hernia treatment might the doctor recommend?
Treatment depends on your symptoms, not on the hernia itself. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| A hiatus hernia found by chance, no symptoms | No treatment | Yes | Not needed |
| Occasional heartburn after meals | Lifestyle changes, and an antacid or alginate | Yes | Not usually needed |
| Heartburn or reflux most days | A proton pump inhibitor, usually for 4 or 8 weeks | Yes | If symptoms continue despite treatment |
| Symptoms that come back when the medicine stops | Longer-term treatment, or a different type of medicine | Yes | For tests if medicines do not help |
| Difficulty swallowing, weight loss, frequent vomiting or upper tummy pain | A camera test (gastroscopy) | Partly | Promptly, for the test |
| Severe symptoms despite medicines | Referral to discuss surgery | Partly | For the operation |
| Chest pain spreading to the arm, neck or jaw, vomiting blood or black poo | Emergency care | No | Call 112 now |
Heartburn that keeps coming back? A doctor can tell you in one consultation which treatment suits you.
See available times →Treatment options for a hiatus hernia
What you can do yourself
- Eat smaller, more frequent meals, and finish eating 3 to 4 hours before bed.
- Raise the head end of your bed by 10 to 20 cm, using blocks or books under the legs.
- Lose weight if you are overweight, and stop smoking.
- Cut down on alcohol and on the foods and drinks that trigger your symptoms.
- Avoid tight clothing around your waist, and find ways to relax.
- Ask a pharmacist about an antacid or alginate, taken with food or soon after eating.
Prescription treatment
A prescription is never issued without a consultation. If lifestyle changes and pharmacy medicines are not enough, the doctor may prescribe a proton pump inhibitor, such as omeprazole or lansoprazole. The usual course is 4 or 8 weeks, and longer if symptoms come back. If it does not help, the doctor may suggest a different type of medicine, such as famotidine. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Extra pillows: propping your head up on pillows can make symptoms worse, so raise the bed itself. Taking antacids regularly for long periods: they ease symptoms but do not cure the problem. Stopping prescribed medicines without speaking to a doctor. Anti-inflammatory painkillers such as ibuprofen, which can make heartburn worse.
Do you need surgery for a hiatus hernia?
Rarely. Surgery is considered when symptoms or complications are not controlled by medicines, when the side effects of medicines are a problem, or when the hernia is large enough to pose a risk. The usual operation is a fundoplication, done by keyhole surgery under general anaesthetic, in which the top of the stomach is wrapped around the lower end of the food pipe.
- Success: the operation works in about 90% of people, but up to half of hernias can come back after many years, and some people need more surgery.
- Hospital stay: usually 1 to 2 days, then 2 to 6 weeks of recovery at home.
- Eating: you move from liquids to soft food to solid food, and it can take up to 6 weeks before you can eat what you want.
- Side effects: bloating, wind and difficulty swallowing can take a few months to settle.
Special situations
Pregnancy
Heartburn is common in pregnancy, and a hiatus hernia is more likely. Ask a pharmacist or doctor which medicines are suitable; the indigestion in pregnancy page covers what helps.
Heartburn while travelling in Europe
Late dinners, rich food and more alcohol on holiday are common triggers. Try to finish eating 3 to 4 hours before bed, keep meals smaller, pack an antacid or alginate, and keep taking any medicine you have been prescribed.
Long-term reflux
Reflux that keeps coming back is covered on the GORD page, and pain or discomfort after eating on the indigestion page.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When a hiatus hernia is treated online, and when you need in-person care
Treated online: heartburn and reflux from a hiatus hernia, lifestyle advice, pharmacy and prescription medicines, and reviews when symptoms come back.
In-person care: difficulty swallowing, weight loss, frequent vomiting or bleeding, camera tests and other investigations, and surgery.
When to get in-person care
Call 112 or go to an emergency department now for:
- chest pain or pressure that spreads to your arm, neck or jaw
- vomiting blood, or material like coffee grounds
- black, tar-like poo
- sudden, severe pain in your chest or upper tummy, with vomiting
Get medical advice the same day for:
- difficulty or pain when swallowing, or food sticking
- losing weight without trying
- vomiting that keeps happening
- indigestion or reflux with pain in the upper tummy
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your symptoms: say what brings them on and how often, and list the medicines you have tried and any tests you have had.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s a hiatus hernia? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? GORD can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about hiatus hernia
What is a hiatus hernia?
A hiatus hernia is part of the stomach moving up into the chest through the opening in the diaphragm where the food pipe passes. It is very common over 50, often causes no symptoms, and only needs treatment if it causes problems.
What are the symptoms of a hiatus hernia?
A hiatus hernia causes heartburn, acid reflux, bad breath, bloating, feeling or being sick, and sometimes difficulty swallowing. Symptoms are often worse after eating, lying down or bending over, and many people have none.
What causes a hiatus hernia?
A hiatus hernia forms when the muscle around the opening in the diaphragm weakens and lets the stomach bulge up. Age over 50, being overweight, pregnancy, and pressure from coughing, straining or heavy lifting make it more likely.
Where is hiatus hernia pain felt in women?
Hiatus hernia pain in women is the same as in men: usually a burning feeling in the middle of the chest, behind the breastbone, or pain in the upper tummy, often after meals. Chest pressure spreading to the arm, neck or jaw needs 112.
What foods should I avoid with a hiatus hernia?
With a hiatus hernia, common triggers are coffee, alcohol, chocolate, and greasy or spicy food, but they vary between people. Eat smaller meals, less fat, and finish eating 3 to 4 hours before bed.
How long does a hiatus hernia flare-up last?
There is no set length to a hiatus hernia flare-up. Symptoms usually come after meals or when lying down, and ease with an antacid. See a doctor if they have not gone after 3 weeks or come most days.
What is the best treatment for a hiatus hernia?
For a hiatus hernia, lifestyle changes first, such as smaller meals and raising the head of the bed, then pharmacy medicines, then a proton pump inhibitor from a doctor. Surgery is for the few people whose symptoms are not controlled by medicines.
Will a hiatus hernia go away on its own?
No, hiatus hernias do not go away, and they usually get worse slowly over time. But most never need treatment, and symptoms can usually be controlled with lifestyle changes and medicines.
How do you stop a hiatus hernia attack at home?
In a hiatus hernia attack, sit or stand upright, loosen tight clothing, and take an antacid or alginate. To prevent the next one, eat smaller meals and finish eating 3 to 4 hours before bed.
Can a hiatus hernia cause shortness of breath?
Yes, a large hiatus hernia can press on the lungs and cause shortness of breath. Breathlessness has other causes too, so it needs a doctor, and severe breathlessness needs 112.
What is a sliding hiatus hernia?
The most common type, about 95% of hiatus hernias, in which the stomach slides up through the opening in the diaphragm. Most people with one never feel it.
Can an online doctor treat a hiatus hernia?
Yes, usually. A doctor can assess hiatus hernia heartburn and reflux by video, advise on lifestyle changes and prescribe acid-reducing medicines. Difficulty swallowing, weight loss, vomiting or bleeding need tests in person.
- Hiatus hernia, NHS, National Health Service (UK), reviewed 8 May 2024.
- Heartburn and acid reflux, NHS, National Health Service (UK), reviewed 20 November 2023.
- Hiatal hernia: symptoms and causes, Mayo Clinic (US), updated 3 July 2025.
- Hiatal hernia, Cleveland Clinic (US), reviewed June 2023.
- Hernia, Cleveland Clinic (US), reviewed February 2023.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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