A hiatal hernia doesn’t cause heartburn, but it is often associated with gastroesophageal reflux disease (GERD), of which heartburn is usually a symptom.
Hiatal hernia is very common, especially in people who are over 50 or obese. A hernia occurs when an internal body part or organ pushes through the wall of the cavity in which it normally resides. It’s called a hiatal hernia when a portion of the stomach slides upward through the esophageal opening (hiatus) of the diaphragm into the chest cavity (normally the diaphragm separates the esophagus from the stomach). In most people, it produces no symptoms, in which case there’s no need to be concerned. (People may learn they have a hiatal hernia only when it shows up incidentally on a medical scan.) Increased pressure in the abdomen caused by obesity, pregnancy, straining on the toilet, heavy lifting, trauma, or coughing may be contributing factors.
While most people with a hiatal hernia don’t have GERD, most people with GERD do have a hiatal hernia. That may be because the backup of stomach acid characteristic of GERD can contribute to the formation or enlargement of a hernia.
In severe cases of hiatal hernia, which are rare, a large portion of the stomach may protrude into the esophagus. That may require surgery, since it can cause a host of serious problems.