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Want to get to the bottom of the cause of your chronic heartburn? Here, we examine the differences between a hiatal hernia and GERD.

Are you suffering from chronic acid reflux, and have you approached your doctor about ways to get rid of heartburn fast? You may just have entered, well, let's say "confusing waters". 

Louise, a forty-something woman from the United States, sought symptom relief through over-the-counter heartburn medications for quite a while before asking her doctor for advice. The result?

"He simply put me down for 'GERD or hiatal hernia' based on the symptoms I described, without offering me any tests or even telling me tests existed. It was very frustrating."

If the same thing happens to you, you may wonder whether GERD and a hiatal hernia are the same things, and whether it matters. Let's take a look at that. 

Are GERD And A Hiatal Hernia Synonymous? 

In short, no. 

A hernia is any situation in which an organ protrudes into a bit of the body where it doesn't have any business being. In the case of a hiatal hernia, a portion of your stomach pushes through the muscular wall that is meant to separate your stomach from your chest, the diaphragm. [1] While there are different kinds of hiatal hernia, the type most commonly associated with chronic heartburn is a so-called sliding hiatal hernia. The opening in the diaphragm that connects your stomach to your esophagus is widened in this type of hiatal hernia. [2]

Meanwhile, gastroesophageal reflux disease (GERD, or GORD if you're from the UK) occurs when the lower esophageal sphincter is weakened or when it relaxes when it shouldn't. This can happen for a variety of reasons, including obesity, pregnancy, and certain medications cause acid reflux as a side effect. The most common symptom of GERD is chronic heartburn, but GERD can also feature nausea and vomiting, bad breath, chest pain, respiratory difficulties, difficulty swallowing, and tooth erosion. [3]

A hiatal hernia is one possible cause of GERD, and its associated chronic heartburn. Once the link between GERD and hiatal hernia was discovered, they were almost considered synonymous. In recent years, however, it has become clear that a multitude of factors contribute to the development of GERD, and that a hiatal hernia is only one of them. It is both possible to have GERD without a hiatal hernia, and a hiatal hernia without GERD — or frequent heartburn, for that matter. [4]

Chronic Heartburn: Do I Need To Know Whether I Have A Hiatal Hernia Or GERD?

Perhaps, but not necessarily. As one study on the clinical significance of hiatal hernia noted:

"The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures." [4]

In real terms, this means that you'll likely be advised to make certain lifestyle modifications first. Following an acid reflux diet, in which you avoid foods that trigger heartburn, is the most proactive step you can take to achieve heartburn relief. Your doctor may advise you to steer clear of tomatoes, peppermint, alcohol, citrus fruitscoffee and chocolate. Avoiding spicy foods and following a low-fat diet, may also help you minimize your episodes of heartburn. [5]

Your doctor will advise you to use antacids and acid reducers to get rid of heartburn, as well as encouraging you to lose weight if you are overweight or obese [6]. You will also want to try natural heartburn remedies such as chewing gum [7] and sleeping with your head in an elevated position [8].

All of these steps can be tremendously helpful, regardless of whether you have a hiatal hernia or not. Should you find that lifestyle modification, an acid reflux diet, natural heartburn remedies, and heartburn medications do not offer you much relief from your heartburn, however, more severe measures may be required. 

That is where testing comes in. 

A hiatal hernia can be diagnosed quite easily using an upper gastrointestinal tract radiography — a special X-ray with a contrast material like barium — or with an endoscopy, during which an instrument called an endoscope is inserted into your digestive tract through your mouth. [9] An esophageal manometry, in which a pressure-sensitive tube is inserted into your digestive tract through your nose, is also sometimes carried out during the diagnostic process. [10]

A GERD diagnosis, meanwhile, is often based on a thorough discussion about the symptoms you are experiencing [11], though esophageal pH monitoring may also be carried out. [12]

Patients with a hiatal hernia do not benefit sufficiently from the endoscopic surgical techniques that are often recommended for those with GERD, but their symptoms are likely to improve with a procedure called a Nissen fundoplication, in which the lower esophageal sphincter is strengthened and the hiatal hernia is repaired. [4]

The Bottom Line

Not everyone who suffers from heartburn as the result of a hiatal hernia needs surgery — in many cases, you will find that lifestyle modifications manage your condition sufficiently. Those people who are still plagued by daily or near-daily episodes of heartburn after following an acid reflux diet and making other changes, however, will want to discuss the risks and advantages of surgery with their healthcare providers. You may need to play a proactive role in your own care to ensure that your doctor is aware just how badly your chronic heartburn is affecting your life, however — do not be scared to advocate for yourself and ask for diagnostic testing if you believe it to be in your best interest. 

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