The diaphragm is a thin sheet of muscle that runs across the top of the stomach. The small opening in the diaphragm where the food pipe (esophagus) and stomach meet is called the hiatus. When you eat, the muscle around the hiatus relaxes to let food pass from the esophagus into the stomach. The hiatus tightens to keep food and acid in the stomach.

In some people, the hiatus is too large or the muscle around it is weak. If this is the case, the top of the stomach can push upward through the hiatus. This is called a hiatal hernia. A hiatal hernia can let stomach acid flow back up the esophagus. This is called acid reflux.

Hiatal hernias are common. You may also hear them called diaphragmatic hernias. The cause of a hiatal hernia is not certain, but some things may make it more likely. Common causes may include obesity, pregnancy, and vomiting or coughing.

Many people with hiatal hernia don't have symptoms. Often the symptoms are like those of GERD (gastroesophageal reflux disease or acid reflux). They can include:

• Burning feeling under the breastbone (heartburn).
• Mild chest pain.
• Frequent burping, especially after meals.
• Food coming back up into the throat or mouth.
• Acid taste in the mouth.
• Trouble swallowing food or liquid.
• Night-time choking, coughing, or wheezing.
• Feeling full after eating only a small amount of food.
• Nausea and vomiting.

Treatment can reduce symptoms. This includes medicines and lifestyle changes. In severe cases, you may need surgery to tighten the hiatus.

Medicines help control symptoms, but they can't fix the hernia.

• Antacids help neutralize the normal acids in your stomach. You may find one works better than another for you.
• Acid blockers (H2 blockers) decrease acid production.
• Acid inhibitors (PPIs) decrease acid production in a different way than the blockers.
• Don't take nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and naproxen. These may make symptoms worse in some people. If you are taking these medicines for another health problem, talk with your doctor before stopping them.

Lifestyle changes are important in treating your symptoms. You can help reduce or ease your symptoms if you:

• Don’t smoke, vape, or use other tobacco or nicotine products. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good. If possible, also avoid secondhand smoke and the aerosol mist from vaping.
• Reach and stay at a weight that is healthy for you. Excess weight puts pressure on the stomach and esophagus. Talk to your doctor if you need help losing weight.
• Limit or stay away from certain foods because they can make symptoms worse. These include fatty, fried, and spicy foods, as well as coffee, chocolate, and mint. Also stay away from foods with high acid content. These include tomatoes and citrus fruit and juices (orange, grapefruit, lemon).
• Eat smaller amounts at a time. Don't get overfull.
• Prop up the head of your bed if you get symptoms overnight. For instance, use 2 bed risers under the frame, at the head of the bed. Or use a wedge pillow to raise (elevate) your head.

Follow up with your doctor. Regular visits may be needed to check on your health. Be sure to take any medicines as prescribed and keep all your appointments. In some cases, you may need surgery to stop symptoms. Your doctor will talk with you about this choice if needed.

Contact your doctor right away if:

• You have severe pain in your chest or belly (abdomen).
• You can't keep down food or liquid.
• Your symptoms get worse.
• You have other symptoms as indicated by your doctor.

Call 911 if you:

• Have trouble breathing or swallowing.
• Have chest pain that gets worse, especially if different from normal.
• Are vomiting blood.
• Have large amounts of blood in your stool.