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Hiatal Hernia

A hiatal hernia is when the top of the stomach pushes up through the diaphragm into the chest. It is common after 50, often causes no symptoms, and is closely linked to reflux and heartburn. Sudden severe chest or belly pain with vomiting or retching needs emergency care.

Chest pain? Call 911 if it could be a heart attack. Don’t assume chest pain comes from your esophagus or a hernia until a doctor has checked for a heart cause (ACG). Heart attack signs include chest pain or discomfort that lasts more than a few minutes or goes away and comes back; pain in the jaw, neck, back, arms or shoulders; shortness of breath; and feeling weak, light-headed or faint (CDC).

Get emergency care (call 911 or go to an emergency room) for:

  • Sudden, severe pain in the chest or upper belly with nausea, vomiting or retching — especially if you know you have a large or paraesophageal hiatal hernia. Rarely, the stomach can twist or get trapped in the chest and lose its blood supply (strangulation), which is life-threatening. Severe upper-belly pain with retching or vomiting is part of the classic warning pattern doctors look for (Ceccarelli et al., 2020, Manterola et al., 2025).
  • Vomiting with severe belly pain or swelling and being unable to pass gas or have a bowel movement — signs of a blocked bowel. Hernias are one of the most common causes, and a complete blockage is a medical emergency (MedlinePlus).

Get urgent medical advice if there is blood in your vomit or it looks like coffee grounds, your stools are black and tarry, swallowing becomes difficult or painful, you keep vomiting, you lose weight without trying, or you have pain in your upper tummy (NHS, NIDDK).

For reflux itself, our Acid Reflux & GERD guide covers testing, medicines and anti-reflux surgery in depth, and our Heartburn guide covers occasional heartburn and over-the-counter medicines. This guide focuses on the hernia.

What is a hiatal hernia?

Your diaphragm is the thin sheet of muscle that separates your chest from your abdomen. The esophagus (food pipe) passes through an opening in it, called the hiatus, to reach the stomach. A hiatal hernia is when the upper part of the stomach bulges up through that opening into the chest (MedlinePlus). In the UK it is called a hiatus hernia (NHS).

Sliding and paraesophageal (rolling) hernias

There are two main types (Volokitin et al., 2022):

Often no symptoms

You can have a hiatal hernia without knowing it and without it being a problem (NHS). People usually find out they have one when they are being tested for reflux, heartburn, chest pain or belly pain (MedlinePlus). If a hiatal hernia isn’t causing symptoms or problems, it doesn’t need treatment (MedlinePlus, NHS). In older people, even paraesophageal hernias often cause no symptoms (Ceccarelli et al., 2020).

The link to reflux and heartburn

Normally, the lower esophageal sphincter and the diaphragm work together to keep stomach contents from coming back up (NIDDK). When part of the stomach sits above the diaphragm, it’s easier for acid to come up into the esophagus (MedlinePlus). The ACG describes a hiatal hernia as one of the “anatomic issues” that can weaken the body’s barriers against reflux (ACG), and NIDDK says a hiatal hernia can raise the chance of GERD or make GERD symptoms worse (NIDDK).

When a hiatal hernia causes symptoms, they are usually the symptoms of reflux: heartburn, bringing up food or bitter fluid, bad breath, bloating, feeling or being sick, and difficulty or pain swallowing (NHS). MedlinePlus adds a dry cough, breathing problems and wearing away of the teeth (MedlinePlus). Large paraesophageal hernias can also cause chest discomfort, upper belly pain, feeling full quickly, trouble swallowing and shortness of breath (Ceccarelli et al., 2020).

How common is it, and who gets it?

Hiatal hernia is a common condition (SAGES guideline, 2024), and very common over the age of 50 (NHS, MedlinePlus).

Complications

Strangulation is rare but serious. In a large paraesophageal hernia, the stomach can twist (acute gastric volvulus), become trapped and lose its blood supply (Manterola et al., 2025). Strangulated giant hiatal hernias are rare, but emergency repair carries significant risks (Ceccarelli et al., 2020). A 2025 review notes that about 1% of people with a paraesophageal hernia develop acute symptoms needing emergency surgery each year (Manterola et al., 2025).

Cameron lesions and anemia. In people with a large hiatal hernia, erosions or ulcers can form in the stomach lining where the stomach passes through the diaphragm. These Cameron lesions can cause hidden bleeding and cause iron-deficiency anemia, or occasionally cause obvious bleeding (Zullo et al., 2018, Kimer et al., 2010). They are easy to miss: in a review of 140 reported patients, 69% had had at least one earlier upper endoscopy before the lesions were found (Zullo et al., 2018). If you have a large hiatal hernia and unexplained anemia, ask your doctor whether this could be the cause.

How it is diagnosed

  • Barium swallow (upper GI series): you drink a chalky liquid called barium and a radiologist watches it on x-ray as it moves through your upper digestive tract. It can show a hiatal hernia, reflux, narrowing and ulcers. You don’t need anesthesia; the most common side effect is constipation from the barium (NIDDK).
  • Upper endoscopy (EGD): a doctor passes a thin, flexible tube with a camera through your mouth to look at the lining of the esophagus, stomach and duodenum, usually after a sedative. It typically takes 10 to 20 minutes, and serious problems are rare (NIDDK).
  • Chest x-ray: another test that can find a hiatal hernia (MedlinePlus).
  • CT scan: in an emergency, a CT scan of the chest and abdomen, along with endoscopy, is a main tool for seeing a trapped or twisted hernia (Ceccarelli et al., 2020).
  • Before surgery, extra tests are usually needed, such as reflux (pH) monitoring (ACG).

Not the same as a hernia in your belly wall

Most hernias are in the belly wall or groin and cause a lump you can see or feel: inguinal (groin) hernias are the most common type, and umbilical hernias are around the belly button (MedlinePlus, NHS). A hiatal hernia is inside the body, in your chest, and usually shows itself through indigestion symptoms such as heartburn or reflux rather than a lump (NHS). A groin hernia bulge that suddenly gets bigger, won’t go back in, or becomes red or very painful needs medical help right away (NIDDK).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Watchful waiting if the hernia causes no symptoms. Reflux treatment (lifestyle changes and medicines) if it does. Surgery — hernia repair, usually with a fundoplication — when symptoms persist despite treatment, for some large paraesophageal hernias, and urgently if the stomach is trapped. Upper endoscopy without insurance typically about $1,500–$10,000+; with insurance, a copay plus 10%–50% coinsurance. Fundoplication hospital charges about $10,000–$25,000+. Barium swallow, CT and paraesophageal repair: cost estimate being researched. Most hiatal hernias need no treatment or are managed like reflux. After keyhole surgery it can take up to 6 weeks to eat normally and a few months for bloating and swallowing trouble to settle; some people need more surgery.
Chiropractic Some chiropractors and osteopaths offer “hiatal hernia adjustments” or visceral manipulation. There is no good evidence that these move a hernia back or repair it. Not a recommended treatment for hiatal hernia, so no cost is listed. The evidence we found is a few small osteopathic studies in GERD and a single case report. Avoid forceful pressure on the upper belly, and never use manipulation for new chest pain.
Acupuncture Not a treatment for the hernia itself. Studied for reflux symptoms in GERD; see the Acid Reflux guide. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. We found no studies of acupuncture for hiatal hernia. GERD studies are encouraging but very low quality, and reviewers don’t recommend it in place of standard treatment.
Herbal medicine No herb repairs a hiatal hernia. For reflux symptoms, see the Acid Reflux and Heartburn guides. Peppermint can cause heartburn. Cost estimate being researched. Herbs won’t change the hernia. Tell your doctor or pharmacist about everything you take.
Massage therapy No role in treating a hiatal hernia. Avoid deep pressure on the upper belly. Not a treatment for hiatal hernia, so no cost is listed. Massage won’t move the stomach back into place, and shouldn’t be used to put off seeing a health care provider.
MBHA Wellness Coach A healthy weight, smaller meals, a gap between eating and lying down, a raised head of the bed, quitting smoking, less alcohol, loose waistbands, and ways to relax. Cost estimate being researched. These changes can ease reflux symptoms from a hiatal hernia. They won’t close the hernia, and they support, never replace, medical care.

Approach 1 of 6

Conventional medicine (AMA)

No symptoms: watchful waiting

If your hiatal hernia isn’t causing symptoms or problems, you don’t need treatment (MedlinePlus, NHS). For people with no symptoms, SAGES found too little evidence to make a firm recommendation about surgery; its expert panel suggested that some selected people may be offered repair, and it stresses shared decision-making (SAGES guideline, 2024). Learn the emergency signs at the top of this page, especially if you have a large paraesophageal hernia.

Reflux symptoms: treat the reflux

Most symptoms of a hiatal hernia are reflux symptoms, so treatment starts the same way: lifestyle changes (see the Wellness Coach section below), then medicines. A pharmacist may suggest antacids or alginates for short-term relief; they won’t cure the problem and shouldn’t be taken regularly for long periods (NHS). If these don’t help, a doctor can prescribe stronger medicines and may arrange tests (NHS, MedlinePlus). Our Acid Reflux & GERD guide explains H2 blockers, proton pump inhibitors (PPIs) and reflux testing, and our Heartburn guide covers over-the-counter choices. Don’t stop a prescribed medicine without talking to a doctor first (NHS).

When surgery is needed

Surgery is usually considered only when other treatments haven’t worked and symptoms stay very bad (NHS) — and urgently if the stomach becomes trapped or twisted (Ceccarelli et al., 2020). See When surgery is considered below.

Cameron lesions

Cameron lesions are mostly treated with acid-lowering medicine (a PPI) and iron, and some people have the hernia repaired (Zullo et al., 2018). A 2021 review of 14 studies found the lesions resolved in 92% of people after hernia surgery, compared with about 67% on PPIs, but surgery had complications in about 4 in 10 patients, much more often after open than keyhole repair (Verhoeff et al., 2021). Most of the studies were retrospective.

What it costs

Without insurance, an upper endoscopy typically costs about $1,500–$10,000 or more, depending on the provider, location, sedation and setting; a biopsy adds to the bill. With insurance, expect an office-visit copay plus 10%–50% coinsurance (CostHelper). For fundoplication, hospital charges have been reported at about $10,000–$25,000 or more, with insured patients typically paying 10%–40% coinsurance up to their yearly out-of-pocket maximum (CostHelper). These are older estimates, and the fundoplication figure is for reflux surgery, not repair of a large paraesophageal hernia. Barium swallow, CT and paraesophageal hernia repair: cost estimate being researched.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Some chiropractors and osteopaths offer a “hiatal hernia adjustment” or visceral manipulation — hands-on techniques on the upper belly meant to move the stomach back into place. We found no good evidence that this moves or repairs a hiatal hernia.

  • The only hiatal hernia report we found is a single case: one woman with a 3 cm hernia whose symptoms improved after osteopathic manipulative treatment (Volokitin et al., 2022). One case can’t show that a treatment works.
  • In GERD, a few small trials exist. In a trial of 60 people, an osteopathic technique aimed at the lower esophageal sphincter improved GERD symptom scores one week later compared with a sham touch (Eguaras et al., 2019). In a trial of 38 people, sphincter pressure rose right after a diaphragm technique (da Silva et al., 2013) — a short-term measurement, not symptom relief. A 70-person trial of four osteopathic treatments reported better quality of life and less medicine use, but its main symptom results couldn’t be interpreted because many questionnaires were filled in wrongly (Lynen et al., 2022).

Safety: mild soreness, stiffness or headache are common after spinal manipulation; serious problems are very rare, and the risk may be higher in people with other health problems (NCCIH). Avoid forceful pressure on the upper belly if you have a hiatal hernia — this is MBHA’s own caution, as no study has tested its safety. And never let new chest pain be treated as a back or rib problem before a doctor has checked your heart (ACG).

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture won’t change a hiatal hernia. Our PubMed search for acupuncture and hiatal hernia found no studies of acupuncture for the hernia itself. For reflux symptoms, the research is on GERD: a 2025 review of 12 studies found manual acupuncture improved symptom scores, but the evidence was very low quality, overall improvement was lower than with PPIs, and the authors didn’t recommend acupuncture alone as the main treatment (Yin et al., 2025). More of that research is described in our Acid Reflux guide.

Safety and cost: relatively few complications have been reported, but nonsterile needles and improper treatment have caused harm, and most states license acupuncturists (NCCIH). A first private visit is about $125–$230, follow-ups about $90–$185, and community clinics about $50–$90 (The Pricer, 2026). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement repairs a hiatal hernia. For reflux symptoms, see our Acid Reflux and Heartburn guides. One caution: peppermint oil can cause heartburn, and acid reflux was among the side effects reported in studies (NCCIH); the ACG lists peppermint among trigger foods (ACG). Tell your doctor or pharmacist about every herb you take.

Approach 5 of 6

Massage therapy

Massage has no role in treating a hiatal hernia, and our PubMed search found no studies of it. If you enjoy massage for relaxation, ask your therapist to avoid deep pressure on your upper belly (MBHA’s own caution) and to raise your head if reflux bothers you lying flat. Rare serious side effects of massage have been reported, some with vigorous deep-tissue work or in older people, and massage shouldn’t be used to put off seeing a health care provider (NCCIH).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build habits that ease reflux from a hiatal hernia, one step at a time:

See a doctor if symptoms don’t go away after 3 weeks, are very bad or getting worse, or pharmacy medicines don’t help (NHS).

Another approach

When surgery is considered

Most people with a hiatal hernia never need surgery. A doctor may refer you to a surgeon if other treatments haven’t worked and you keep having very bad symptoms (NHS). Some people without symptoms may be offered repair (SAGES guideline, 2024). Other reasons include bleeding Cameron lesions (Verhoeff et al., 2021) and, urgently, a trapped or twisted stomach (Ceccarelli et al., 2020). Our Surgery guide is coming soon.

What the operation involves

  • Keyhole surgery (laparoscopy), through small cuts in the tummy under general anesthetic, is usually used (NHS).
  • Fundoplication — sewing the top of the stomach around the end of the esophagus to help prevent reflux — is the most common reflux operation (NIDDK), and the 2024 SAGES guideline suggests routinely adding one when repairing a hiatal hernia, though that advice rests on low-certainty evidence. The evidence on using mesh was mixed, and SAGES made no recommendation (SAGES guideline, 2024).
  • For people with GERD and obesity, a doctor may suggest weight-loss surgery, most often gastric bypass (NIDDK).
  • Before a decision, you will usually need more tests, and the ACG recommends seeing both a gastroenterologist and a surgeon experienced in reflux surgery (ACG).

What to expect

Member stories

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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