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What\’s the Difference Between Acid Reflux and Hiatus Hernia?

People with burning discomfort in the upper part of their stomach often say that they have “heartburn.” If they go to one doctor they might be told that they have acid reflux. Another physician might tell them that they have an hiatus hernia. Having two diagnoses for the same complaint naturally raises some questions. What’s going on? What’s the difference between acid refux and hiatus hernia?

Well, hiatus hernia and acid reflux often go together, but they are not the same thing. Hiatus hernia refers to an anatomic change (the presence of a hernia) while acid reflux refers to an abnormal change in the way things work (abnormal physiology).

In an hiatal hernia acid reflux , part of the stomach slides out of the abdominal cavity into the chest. The opening in the diaphragm that the esophagus goes through to enter the abdomen is known as the esophageal hiatus, hence the name hiatus hernia. That’s the abnormal anatomy.

Acid reflux refers to acid from the stomach backing up (refluxing) into the esophagus. That normally doesn’t happen if everything is working normally, so that’s the abnormal physiology.

So why are these two terms sometimes used interchangeably? Well, strictly speaking they probably shouldn’t be. However, most of the time when someone has a hiatus hernia the hernia and the stomach sliding into the chest causes the muscle that acts like a one-way valve between the esophagus and the stomach to malfunction. This leads to reflux and the idea that they’re closely associated flows from there.

It’s very important to note that not everyone with a hiatus hernia has reflux. On the other side of the coin, a hernia isn’t the only cause of reflux. Many people have reflux without having a hernia.

I hope this helps you see why these two terms are often heard together and why their meaning is sometimes confused. There used to be a tendency to use them interchangeably but that’s becoming less common as more and more people are becoming familiar with the concept of acid reflux.

While I’m at it, I suppose I should also mention some other terms associated with acid reflux. It may be called acid reflux disorder or acid reflux disease. A more formal term is gastroesophageal reflux disease. You’ll likely see this abbreviated as GERD. I’m sure there are some other terms out there, and I sure docs have some very fancy names that they use, but these are the most common ones that I know about.