What is hiatus hernia?
A hiatus hernia occurs when the top of the stomach pushes up through the opening (hiatus) in the diaphragm that the oesophagus passes through. Many people have one without knowing, but it can weaken the valve mechanism at the top of the stomach, allowing acid to reflux into the oesophagus and cause heartburn, regurgitation and chest discomfort.
Hiatus hernias become more common with age and are also linked to being overweight, pregnancy and heavy straining. They are usually found during a gastroscopy (a camera test into the stomach) arranged to investigate reflux symptoms, or on a barium swallow X-ray or CT scan. Larger hernias occasionally cause difficulty swallowing, anaemia or a feeling of fullness after small meals.
Common symptoms
- Heartburn, especially after meals or when lying down
- Regurgitation of food or sour liquid
- Burping and bloating
- Chest or upper abdominal discomfort
- Difficulty swallowing or food sticking
- A persistent cough or hoarse voice, particularly in the morning
- Feeling full quickly with larger hernias
How long will you wait?
After a routine referral, NHS patients often wait several weeks for a gastroscopy and then four to nine months more for anti-reflux surgery where it is needed, so the full pathway commonly stretches well beyond the 18-week standard.
Privately, you can typically see a consultant within 3–7 days, have a gastroscopy within 1–2 weeks, and surgery, if needed, within 2–6 weeks.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Lifestyle changes. Losing weight, eating smaller meals, avoiding late eating and raising the head of the bed all reduce reflux from a hiatus hernia.
- Acid-suppressing medication. Proton pump inhibitors such as omeprazole control acid and relieve symptoms for the majority of people.
- Laparoscopic repair and fundoplication. Keyhole surgery returns the stomach to the abdomen, repairs the hiatus and wraps the top of the stomach to stop reflux.
What does private treatment cost?
As a guide, a private gastroscopy typically costs around £1,300–£2,000, while laparoscopic hiatus hernia repair with fundoplication is typically around £6,500–£9,500 in the UK in 2026.
Does health insurance cover hiatus hernia?
Private medical insurance will usually cover investigation of new reflux symptoms and surgical repair of a hiatus hernia diagnosed after your policy starts, since surgery offers a definitive fix for an acute problem. Long-standing reflux or a hernia diagnosed before you joined is likely to be excluded as pre-existing at first. Ongoing prescription of everyday acid-suppressing medication is generally not covered, as insurers class this as routine or maintenance treatment.
Frequently asked questions
Do all hiatus hernias need surgery?
No, most do not. The majority of people manage well with weight loss, meal and lifestyle adjustments, and acid-suppressing tablets. Surgery is usually reserved for people whose symptoms persist despite good medical treatment, who cannot or prefer not to take long-term medication, or who have large hernias causing swallowing problems, anaemia or volume-related symptoms.
What does keyhole hiatus hernia surgery involve?
Through four or five small incisions, the surgeon draws the stomach back into the abdomen, narrows the enlarged opening in the diaphragm with stitches, and usually performs a fundoplication, wrapping the top of the stomach around the lower oesophagus to recreate the anti-reflux valve. Most people stay one night in hospital and eat a modified soft diet for a few weeks afterwards.
Is a hiatus hernia dangerous?
Usually not. Most cause reflux symptoms rather than serious harm, though long-term acid exposure can inflame the oesophagus and, in some people, lead to Barrett's oesophagus, which needs monitoring. Large rolling (paraoesophageal) hernias carry a small risk of the stomach twisting or becoming obstructed, which is why surgeons monitor these more closely and repair them more readily.