Reflux & Hiatus Hernia

Hi all,

I'm wondering is Reflux & Hiatus Hernia the same thing?

As I have asthma & reflux & may now also have Hiatus Hernia as was rushed on Wednesday morning to see my doctor as I had chest pain & stomach pain this started just as I went to have my breakfast but never did. the dr did an ecg of heart which is very good & my oxygen levels were good too I was terrified thinking was my heart as in excruiating pain.

Hes put me on (Generic brand Somac 40mg once a day) Pantoprazole.

Hiatus Hernia does run in the family. I'm glad I dont get the stomach cramps now like i did on Wednesday.

I'm a little overweight & know I have to lose it & I know the foods I cant eat & not eating 2-3hrs before I go to bed.

I have to go back to the doctor on wednesday for another check up & see if the tablets are helping.

Has anyone else got Reflux & Hiatus Hernia.?

I would like to know some more info on Hiatus hernia dont fully understand it have looked on the net.



4 Replies

  • Hi,

    I have had severe acid reflux and hiatus hernia for about 20 years. I think the reflux is where the acid gets back up due to a loose valve ( sorry not very medical ! ) and the hernia is a hole or abrasion,mine has since healed. I have been taking the ....prazole family of proton pump inhibitors for all those years and they are very effective with little known side effects. Years ago I was offered surgery called the Enteryx procedure which claimed to help but I don't think its now offered due to a high failure rate. I don't know of any other surgery but I'm sure some of our medical professionals may be able to advise. I am sure reflux and asthma are connected as I only developed it about 5 years ago and now suffer badly, having been on pred for 2 years and now methotrexate and all the usual stuff.

  • Thank you for the reply any info helps as I'm becoming confused what may be affecting what (if you know what I mean LOL).


  • Hi Shazza,

    I'm sorry to hear that you've acquired this new diagnosis; hopefully by now the tablets are helping a little and you are feeling a little better.

    Reflux and hiatus hernia are not the same thing, but they are related. It is possible to have a hiatus hernia without reflux, or indeed to have reflux without a hiatus hernia, but they do occur more commonly together.

    Basically, the oseophagus (gullet or food pipe) normally runs from the mouth through the chest and passes through a small hole in the diaphragm, where it joins to the stomach. There is a valve between the oesophagus and the stomach (the gastro-oesophageal junction) which helps to prevent stomach contents from refluxing back up the oesophagus. This valve, and the whole of the stomach, should normally sit below the diaphragm in the abdomen.

    Reflux occurs when the gastro-oesophageal junction is not working properly. The acidic stomach contents pass up from the stomach into the oesophagus. Because the oesophagus is not designed to withstand the effects of acid, this can cause irritation and the symptom of heartburn, which is felt as a burning central chest pain. Acid regurgitation into the mouth or the back of the throat may also be felt. Reflux can also make asthma worse by acid irritating the airways, and can cause chronic cough and hoarseness.

    The causes of reflux are not completely understood. Anything that has the effect of relaxing the gastro-oesphageal junction can contribute - bronchodilator drugs taken for asthma, such as salbutamol or theophylline, can have this effect, as they act on all smooth muscle, not just the airways. Other drugs that relax smooth muscle, such as GTN (for angina) and calcium channel blockers (for angina, palpitations or high blood pressure) can also have this effect. Obesity and pregnancy predispose to reflux by increasing the pressure in the abdomen.

    Hiatus hernia occurs when the diaphragmatic muscles become slack and the hole in the diaphragm becomes enlarged, allowing a portion of the stomach to protrude up through the diaphragm into the chest cavity. Usually, with the most common type of hernia, the valve at the gastro-oesophageal junction protrudes up through this hole as well.

    The reasons why hiatus hernia develops are also not completely understood. The muscle of the diaphragm becomes more slack as we get older, so it is more common in the elderly. Obesity, pregnancy and straining due to constipation are all thought to predispose to the development of a hiatus hernia by increasing the pressure inside the abdomen. It's not known, though, why some people with these risk factors get a hiatus hernia and others don't.

    Many people with hiatus hernia have no symptoms and will not be aware that they have it. It's not considered a disease, as such, in these people, and doesn't cause them any harm. The presence of a hiatus hernia does make reflux more likely, though, because the gastro-oesophageal junction cannot function properly when it has herniated through the diaphragm. Very occasionally, other complications can occur, such as ulceration and bleeding of the herniated portion of the stomach, or obstruction of the stomach, but these things are extremely rare.

    The symptoms of reflux with hiatus hernia and reflux without hiatus hernia are very similar, so it's not usually possible to make a firm diagnosis of hiatus hernia based on symptoms and examination alone. To confirm the diagnosis of hiatus hernia, further tests such as a barium meal or an endoscopy are usually needed. However, these tests are not usually done initially, as the initial treatment is the same whether there is a hiatus hernia or not. If initial treatment is not successful, then further tests might be considered.

    The treatment, as you know, is to start a Proton Pump Inhibitor (PPI) such as omeprazole, lansoprazole or pantoprazole. This stops acid secretion in the stomach - it doesn't prevent the reflux, as such, but it stops it being acidic and irritating and damaging the oesophagus. For most people, this is sufficient to treat the symptoms and to prevent the reflux from worsening asthma symptoms. Sometimes other drugs are given to help the stomach to empty more quickly.

    If the symptoms are persistent, and especially if worsening of asthma is a major problem, surgery is occasionally done for both hiatus hernia and for reflux without hiatus hernia. The most commonly done operation nowadays is a Nissan fundoplication - this involves pulling the stomach down through the hole in the diaphragm back into the abdomen and stitching the top part of the stomach around the gastro-oesophageal junction, increasing the pressure on it and preventing reflux. It's usually done laproscopically (by keyhole surgery) and usually isn't too big a procedure.

    Hope this makes things a little clearer and that the tablets are of some use to you.

    Take care

    Em H

  • Thank you so much for all that very informative information Em H it has helped me tremondously.

    But I have good news, I don't have Hiatus Hernia now it was a very bad case of Reflux apparently, Dr has put me on Ranitidine one tablet of a night plus still I take 1 tablet Nexium of a morning I'm releived it's nothing too serious,

    I have lost 1kg in the last week though as I'm not feeling hungry, Dr said can't afford to put on weight as that makes Reflux worse which I know that now.

    I'm on a diet now cutting out all the unhealthy foods & eating healthier. But I never ate too much unhealthy foods only if under stress/worry I go for the wrong foods chips & chocolates mainly chips as a comfort food.

    We won at tennis last night too

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