Hiatal Hernia vs. Heartburn: How to Tell the Difference

Chest discomfort after meals can leave you wondering: is it just heartburn, or something more serious like a hiatal hernia? While both conditions share overlapping symptoms, they are not the same. Understanding the difference is key to getting the right treatment and relief.

What Is a Hiatal Hernia?

A hiatal hernia happens when part of the stomach pushes through the diaphragm into the chest cavity.

Hernia Types include:

• Sliding hiatal hernia: The stomach and lower esophageal sphincter (LES) slide upward into the chest.
• Paraesophageal hernia: The LES stays in place, but part of the stomach bulges next to the esophagus.

Causes: age-related muscle weakness, obesity, chronic coughing, smoking, or injury.

Symptoms:

• Heartburn or acid reflux
• Regurgitation of food or liquid
• Difficulty swallowing
• Chest pain or shortness of breath
• Feeling of fullness after eating

What Is Heartburn?

Heartburn (acid reflux) is a burning sensation in the chest caused by stomach acid flowing back into the esophagus. It is often a symptom of GERD (gastroesophageal reflux disease).

Common triggers:

• Weak LES function
• Spicy, fatty, or acidic foods
• Caffeine and alcohol
• Obesity or pregnancy
• Smoking

Symptoms:

• Burning chest sensation
• Sour or bitter taste in the mouth
• Regurgitation of food or liquid
• Difficulty swallowing
• Chronic cough or sore throat

Comparing Symptoms

Shared symptoms: heartburn, regurgitation, and difficulty swallowing.

Unique to hiatal hernia: chest pain, shortness of breath, fullness after meals.
Unique to heartburn: sour taste, chronic cough, sore throat.

Severity & frequency:

• Hiatal hernia → often persistent, worsens with activity or lying down.
• Heartburn → intermittent, often triggered by certain foods or habits.

Diagnosing the Difference

Hiatal hernia tests:

• Endoscopy
• Barium swallow X-ray
• Esophageal manometry

Heartburn tests:

• pH monitoring for acid levels
• Endoscopy (to rule out damage)
• Manometry for esophageal function

Treatment for Hiatal Hernias

Lifestyle changes:

• Avoid trigger foods (spicy, fatty, acidic)
• Maintain a healthy weight
• Stop smoking
• Avoid heavy lifting and straining

Medications:

• Antacids (neutralize acid)
• H2 blockers (reduce acid)
• Proton Pump Inhibitors (block acid production)

Surgery (for severe cases):

• Laparoscopic repair (minimally invasive)
• Robotic-assisted hernia surgery
• Open repair for complex cases

Treatment for Heartburn

Lifestyle changes:

• Eat smaller, more frequent meals
• Avoid late-night eating
• Limit caffeine, alcohol, and acidic foods
• Elevate head during sleep

Medications:

• Antacids
• H2 blockers
• Proton Pump Inhibitors

When to Seek Medical Help

Seek urgent care if you have:

• Severe chest pain
• Difficulty breathing
• Vomiting blood or black stools

See a specialist if you experience:

• Chronic heartburn more than twice a week
• Ongoing regurgitation or swallowing difficulties
• Persistent cough, sore throat, or hoarseness

Prevention and Long-Term Management

• Follow prescribed diet and lifestyle changes
• Maintain regular follow-up with your healthcare provider
• Consider stress management, which can worsen reflux symptoms

Expert Care at Hernia Innovations

At Hernia Innovations by BASS Medical Group, we diagnose and treat both hiatal hernias and chronic reflux. Our specialists offer minimally invasive procedures, advanced diagnostics, and personalized care across Walnut Creek, Brentwood, Concord, and Antioch.

Call us at (925) 940-1025 or request an appointment online today.

FAQs

What are the main differences between a hiatal hernia and heartburn?‍

Hiatal hernia is a structural issue (stomach pushing through diaphragm), while heartburn is acid reflux.

Can you have both a hiatal hernia and heartburn?‍

Yes—hiatal hernias often trigger reflux, making heartburn more likely.

When does a hiatal hernia need surgery?‍

If symptoms are severe, persistent, or complications develop (like paraesophageal hernia), surgery may be recommended.

Do lifestyle changes really help?‍

Yes—healthy diet, weight management, and avoiding triggers significantly reduce symptoms for both conditions.