What Is a Hiatal Hernia?

Heartburn that keeps coming back has a short list of usual explanations, and one of the less obvious ones sits right where your food pipe meets your stomach. Could part of the stomach itself have slipped out of place? That is exactly the question the short video above — just over a minute long — sets out to answer, and it does so with a definition worth slowing down for.

So what has actually moved?

As the video explains, a hiatal hernia (also called a hiatus hernia) is the protrusion of the upper part of the stomach into the chest through the esophageal hiatus, because of a tear or weakness in the diaphragm. The diaphragm is the broad muscle sheet that separates your chest from your abdomen, and the hiatus is the small opening in it that the food pipe passes through on its way to the stomach. When that opening weakens, the top of the stomach can push upward through it. Nothing has burst or broken open — a portion of the stomach is simply sitting a little higher than it should. If you want to watch that movement rendered clearly, this site's companion clip, "Hiatal Hernia 3D Medical Animation", shows the stomach sliding up through the diaphragm in about a minute of animation.

Would you feel it — and what does it feel like?

Plenty of people feel nothing at all, and the hernia is only noticed on a scan or a scope done for another reason. When there are symptoms, the video is specific about the pattern: hiatus hernias often result in heartburn, but may also cause chest pain or pain with eating. That makes sense once you picture the anatomy — a stomach that has moved upward sits closer to the valve that is supposed to keep acid down, so reflux becomes easier. The overlap with ordinary reflux is real, which is why our article on acid reflux (GERD) makes useful companion reading: a hiatal hernia is one of the structural reasons reflux can keep happening. One caution belongs here rather than in the small print — chest pain should always be assessed promptly in person, because it has causes far more urgent than a hernia.

How is the diagnosis actually made?

Usually not by examination alone, because the hernia is internal. The finding typically comes from investigations aimed at the symptoms: an endoscopy, where a slim camera passes down the food pipe and can see the stomach's position directly, or imaging studies that show the top of the stomach above the diaphragm. Your clinician pieces it together from what those tests show alongside the symptom story you describe. You do not need to guess at any of this yourself — persistent heartburn, pain with eating, or trouble swallowing are the cues to book the appointment and let the tests do the talking.

And once it is found, what happens next?

That depends on size and symptoms, and it is a conversation rather than a foregone conclusion. A small hernia causing little trouble may simply be monitored while the reflux it contributes to is managed. Larger hernias, or ones behind significant symptoms, can lead to a discussion about procedural or surgical repair with the specialist team — the same broad territory covered by our general article on what a hernia is and how it is repaired, though the hiatal type has its own approaches. Either way, finding one is information, not an emergency in itself: it explains symptoms that may have puzzled you for a long while, and it gives the team something concrete to work with.

Frequently Asked Questions

Is a hiatal hernia the same as a hiatus hernia?
Yes. The anchor video uses both names for the same thing: the upper part of the stomach protruding into the chest through the esophageal hiatus in the diaphragm.

What causes a hiatal hernia?
The video attributes it to a tear or weakness in the diaphragm at the opening the food pipe passes through, and names obesity as the most common cause. Weakness at that opening is what allows the stomach to push upward.

Does a hiatal hernia always cause heartburn?
No. The video notes that hiatus hernias often result in heartburn but may also cause chest pain or pain with eating — and some cause no symptoms at all and are found incidentally.

How is a hiatal hernia diagnosed?
Typically through investigations for the symptoms, such as an endoscopy or imaging, which can show the top of the stomach sitting above the diaphragm. It is not something that can be confirmed by examination alone.

Does every hiatal hernia need surgery?
No. Management depends on the hernia's size and the symptoms it causes. Small, quiet hernias may simply be monitored, while larger or troublesome ones can lead to a discussion about repair with a specialist team.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about hiatal hernia, not medical advice and not a diagnosis. Chest pain should always be assessed promptly in person, and persistent heartburn or trouble swallowing should be discussed with a clinician.