Most of us have experienced occasional heartburn or acid reflux. It’s easy to blame spicy food, late-night snacking or stress, but persistent symptoms may point to something more serious. 

If you’re dealing with chronic acid reflux, shortness of breath or an uncomfortable tightness in your chest, the real issue might be a hiatal hernia. This condition, commonly paired with gastroesophageal reflux disease (GERD), can affect not only your digestion but also your respiratory function.

A hiatal hernia occurs when the upper part of the stomach pushes through the diaphragm’s opening (the hiatus) and into the chest cavity. This shift can weaken the lower esophageal sphincter (LES)—the valve that prevents stomach acid from rising into the esophagus. When the LES fails, acid escapes upward, triggering hallmark GERD symptoms like heartburn, regurgitation and chronic coughing.

GERD can do more than upset your stomach. It can also affect your breathing. Exercise intolerance or shortness of breath may have nothing to do with your heart. Instead, they could stem from acid irritating the vagus nerve, which helps regulate heart rate and digestion. When the vagus nerve is inflamed, it can cause throat tightness, wheezing or a cough that doesn’t respond to standard respiratory treatments.

If any of this sounds familiar, don’t ignore them. Your doctor may recommend tests such as a barium swallow or endoscopy to confirm the diagnosis.

The good news? A combination of lifestyle changes, dietary adjustments and medications—such as famotidine, proton pump inhibitors (like omeprazole) and antacids—can ease symptoms. These medications work by reducing stomach acid, but long-term use can strip your system of vitamins and minerals.

If medications aren’t enough or aren’t well tolerated, there are minimally invasive procedures. Transoral Incisionless Fundoplication (TIF) is one outpatient option that rebuilds the valve between the stomach and esophagus using a scope through the mouth. Another is the LINX procedure, which uses a magnetic ring to reinforce the LES and does require small incisions. A gastroenterologist can help determine which approach is right for you based on the extent of the damage.

The connection between GERD, hiatal hernia and respiratory issues is often missed—but it can have a major impact on your quality of life. Many people are referred to cardiologists for shortness of breath or fatigue without considering a digestive cause. 

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