Hernia. GERD. COPD. What’s the Connection?

Here’s Important Information About Hiatal Hernias That Can Help You Better Manage Your COPD. 

Hiatal hernia, GERD (gastroesophageal reflux disease, also known as acid reflux or chronic heartburn), and COPD (chronic obstructive pulmonary disease). You probably know the names. But did you know there may be a link between these three conditions?

The link between GERD and COPD: Up to 50% of people with COPD also have GERD, a condition that occurs when the gastric acid in your stomach flows up into your food pipe (esophagus) rather than down into your small intestine. This happens when the valve between your stomach and esophagus doesn’t close properly.

GERD can make it harder to manage COPD, which may lead to worsening symptoms and exacerbations. 

The link between hiatal hernias and GERD: People can have a hiatal hernia without having GERD—or GERD without having a hiatal hernia. And some people may have both. But there is no definitive proof that one causes the other.

However, research does demonstrate that people with a hiatal hernia may be more likely to have GERD. And that hiatal hernias can also exacerbate the symptoms of GERD.

The link between all three: Studies also reveal that hiatal hernias occur in older, more obese people who have GERD. And that hiatal hernias occur significantly more often in people with COPD.

Lesley Williams, Apria’s Market Clinical Trainer and respiratory therapist says,  “Now that we know hiatal hernias are linked to both conditions, it’s important to have a better understanding of hiatal hernias so that you can more effectively manage your COPD.”

What Is a Hiatal Hernia?

A hiatal hernia happens when the upper part of your stomach bulges through an opening in the diaphragm (hiatus) and into your chest cavity. The diaphragm is the muscular wall separating the chest cavity from your abdomen. The opening in the diaphragm connects the esophagus and stomach, allowing food and liquid to pass.

A large hiatal hernia can allow food and acid to back up into your esophagus, causing GERD. It can also cause your stomach to put pressure on your diaphragm or lungs, causing shortness of breath.

Who’s at Risk of Developing a Hiatal Hernia?

People who are overweight, over 50 years old, and who smoke (also the risk factors for COPD) are more likely to develop a hiatal hernia. Pregnancy is also a risk factor for hiatal hernia.

It’s not always clear why hiatal hernias develop. But they can be caused by:

  • Weakened diaphragm muscles
  • Abdominal muscle strain due to persistent coughing, straining during bowel movements, or lifting heavy objects
  • Being born with a very large hiatus

What Are the Symptoms of Hiatal Hernia?

Often, there are none—especially with a small hiatal hernia. However, large hiatal hernias can cause the same symptoms as GERD:

  • A burning sensation in your chest
  • Regurgitating food or sour, bitter-tasting gastric acid into your throat or mouth
  • Chest or abdominal pain
  • Difficulty or pain when swallowing (dysphagia)
  • Fatigue
  • Nausea
  • A lump in your throat
  • Indigestion
  • Coughing, wheezing, frequent burping
  • Ear, nose, and throat problems

How Is a Hiatal Hernia Treated?

If you are experiencing symptoms, there are a variety of effective treatments available.

  • Changes in lifestyle, such as quitting smoking, eating smaller meals throughout the day, avoiding foods that cause heartburn (fatty or fried foods, alcohol, acidic foods like tomato sauce or citrus juices), and maintaining a healthy weight
  • Over-the-counter medications such as antacids, which neutralize stomach acid (Tums, Rolaids), H2 blockers, which reduce acid production (Tagamet HB, Pepcid AC), and proton pump inhibitors (Prevacid, Prilosec), which are stronger than H-2-receptor blockers
  • Medications that your doctor will prescribe
  • In some cases, surgery is appropriate for those who aren’t helped by medications or are having such complications as severe inflammation or narrowing of the esophagus
  • A laparoscopic (minimally invasive) surgery called Nissen Fundoplication is 90% effective in repairing hiatal hernias and GERD

Making Sense of a Complicated Relationship

Now that you have a better understanding of hiatal hernia, GERD, and how they affect COPD, you’ll be better prepared to deal with all three to ensure your overall health and well-being. Apria’s Lesley Williams adds, “If you have any questions, don’t hesitate to contact your healthcare team.”


1. Kim C, et al. Hiatal Hernia on Chest High-Resolution Computed Tomography and Exacerbation Rates in COPD Individuals. Chronic Obstr Pulm Dis. 2016;3(2):570-579. 
2. Hiatal hernia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hiatal-hernia/symptoms-causes/syc-20373379.
3. Hiatal Hernia. Cleveland Clinic.  https://my.clevelandclinic.org/health/diseases/8098-hiatal-hernia.
4. Tricarico, E. (2018, April 27). Connecting the Dots: Understanding the Link Between Hiatal Hernia and GERD. Everyday Health. https://www.everydayhealth.com/gerd/gerd-and-hiatal-hernia.aspx.
5. Roth, E. (2020, April 13). Hiatal Hernias and Acid Reflux. Healthline.
6. Minimally Invasive and Gastrointestinal Surgery. Medical College of Wisconsin. https://www.mcw.edu/departments/surgery/divisions/minimally-invasive-and-gastrointestinal-surgery/patient-care/gerd-and-gastrointestinal-surgery-program/paraesophageal-hernia-hiatal-hernia.
7. Johnson, C. (2021, July 10). COPD and GERD: What is the link between the two? Carenity. https://www.carenity.us/condition-information/magazine/news/copd-and-gerd-what-is-the-link-between-the-two-1036.
8. Leader, D. (Updated 2022, June 12). Living With GERD and COPD. VeryWell Health. https://www.verywellhealth.com/how-common-is-gerd-in-copd-914675#:~:text=2%EF%BB%BF%20GERD%20also%20appears,exacerbation%20if%20you%20have%20COPD.
9. Bryson, S. (2020, March 12). Acid Reflux Linked to Higher Risk of COPD Exacerbations, Review Suggests. COPD News Today. https://copdnewstoday.com/news/gerd-acid-reflux-linked-higher-risk-acute-copd-exacerbations-review-suggests/.

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About the AuthorApria

Apria is a leading provider of home healthcare equipment and related services across the USA, offering a comprehensive range of products and services for in-home care and delivery of respiratory therapy, obstructive sleep apnea treatment, and negative pressure wound therapy, along with additional equipment and services.