A finding on the report is not always the cause
When a report mentions a hiatus hernia, I check whether your main problem is reflux, difficulty swallowing, iron deficiency or something else. The hernia may contribute to symptoms, but it may also be an incidental finding, which is very common at the time of gastroscopy. Even a large hiatus hernia may remain asymptomatic and free of complications. A difference in the measured size between examinations can also reflect breathing or how the stomach was inflated.
When reflux is present, it is usually treated with medicines such as omeprazole, although an operation may also be considered in selected cases. The size on the report alone is not a reason for surgery. If an operation is being considered, I review how the stomach is positioned, your symptoms and the other test results.
Guidance behind this advice
What changes in a hiatus hernia?
Usual anatomy
The food pipe passes through the diaphragm to meet the stomach below it.
Usual anatomy
The food pipe passes through the diaphragm to meet the stomach below it.
Sliding hernia
The junction and an upper part of the stomach move above the diaphragm. Size and position vary.
Para-oesophageal hernia
In this example the junction stays below the diaphragm, while part of the stomach moves up alongside the food pipe. Some hernias combine both patterns.
Sliding hernia and reflux
A sliding hernia can weaken the barrier against reflux, allowing stomach contents to move up into the food pipe. This may cause heartburn, regurgitation or irritation, although many people have no symptoms. Persistent reflux can inflame the oesophagus and, in some people, lead to narrowing or Barrett’s oesophagus.
Simplified illustrations, not to scale. These show an example, not your own anatomy or test result.
Read every diagram explanation
Usual anatomy
The food pipe passes through the diaphragm to meet the stomach below it.
Sliding hernia
The junction and an upper part of the stomach move above the diaphragm. Size and position vary.
Para-oesophageal hernia
In this example the junction stays below the diaphragm, while part of the stomach moves up alongside the food pipe. Some hernias combine both patterns.
Sliding hernia and reflux
A sliding hernia can weaken the barrier against reflux, allowing stomach contents to move up into the food pipe. This may cause heartburn, regurgitation or irritation, although many people have no symptoms. Persistent reflux can inflame the oesophagus and, in some people, lead to narrowing or Barrett’s oesophagus.
Where is a hiatus hernia?
The oesophagus (food pipe) carries food from your mouth to your stomach. It passes through an opening in the diaphragm, the sheet of muscle that separates your chest from your abdomen and helps you breathe. This opening is called the hiatus.
Normally, the stomach sits below the diaphragm, mainly on your left side. In a hiatus hernia, part of the stomach moves up through the oesophageal opening into the chest. This is a change in position. It is not a hole in the bowel or a tear made by the gastroscopy.
Are there different types?
A sliding hiatus hernia is the most common type. The junction between the oesophagus and stomach, together with the upper stomach, moves above the diaphragm. Its position and measured size can vary with breathing and during the examination.
In a para-oesophageal hernia, part of the stomach rises beside the oesophagus. In a type II hernia the junction stays below the diaphragm. Larger hernias can combine both patterns, with the junction and more of the stomach above the diaphragm. These need a different assessment from a small sliding hernia.
Does it explain my symptoms?
The lower oesophageal muscle and the diaphragm work together to limit reflux. A hiatus hernia can weaken this barrier, allowing stomach contents to come back up. This can cause heartburn or an acid taste. Reflux can also occur without a hernia, and many people with a hernia have no symptoms.
A larger hernia can sometimes cause difficulty swallowing, early fullness, discomfort after meals or iron deficiency from small areas of stomach irritation. I do not assume that every symptom comes from the hernia. Chest pain, persistent vomiting or difficulty swallowing may need separate investigation.
What treatment might help?
For a small sliding hernia, treatment usually focuses on reflux if it is causing symptoms. Acid-reducing medicines can relieve symptoms and heal reflux inflammation. They do not move the stomach back below the diaphragm.
Smaller meals, avoiding lying down soon after eating and raising the head of the bed can help some people. If appropriate, gradual weight reduction and stopping smoking can also improve reflux. Food triggers vary. There is no need to exclude a long list of foods that do not cause you symptoms.
Surgery is considered for selected people, including some with troublesome proven reflux despite treatment, or a large para-oesophageal hernia causing symptoms or complications.
The decision includes your health, the anatomy and the benefits and risks of repair. I may arrange further tests and a surgical opinion. Finding a hernia does not by itself mean you need an operation.
Will I need another gastroscopy?
A small hiatus hernia by itself does not usually require regular gastroscopy. Follow-up depends on associated findings, such as significant oesophagitis or Barrett’s oesophagus, and on your symptoms.
I will document your recommended follow-up in your endoscopy report and/or histology report once any tissue results are available. Let me or your GP know if treatment is not helping or swallowing becomes difficult.
When to get help
Arrange a review for new difficulty or pain with swallowing, unexplained weight loss, ongoing vomiting or symptoms that persist despite treatment.
Seek urgent medical assessment for sudden severe chest or upper abdominal pain, repeated retching or vomiting, inability to swallow, vomiting blood or black tarry stools. These symptoms should not be assumed to be ordinary reflux.
Call 111 for new severe chest pain, especially with breathlessness, sweating or faintness, or if you collapse or are too unwell to travel safely.
Three things to remember
- A hiatus hernia means part of the stomach is above the diaphragm through the oesophageal opening.
- A small sliding hernia often needs no treatment unless it is associated with troublesome reflux.
- Large or para-oesophageal hernias need individual assessment. Surgery is not automatic.
Related information
Sources and further reading
English clinical master checked 15 October 2026.