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Hiatal hernia

A hiatal hernia means that the top part of the stomach slides up into the chest cavity. Common symptoms include heartburn, chest pain and the feeling of a lump in the throat. You can treat a hiatal hernia by strengthening your diaphragm with a simple daily routine.

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What is a hiatal hernia?

A hiatal hernia is a weakening of a muscle called the diaphragm. The weakening causes the upper part of the stomach, where the lower oesophageal sphincter is located, to incorrectly slide up above the diaphragm.

When the lower oesophageal sphincter is above the diaphragm, corrosive stomach acid can leak into the oesophagus, causing unpleasant symptoms such as heartburn, chest pain and coughing.

Specialist nurse Charlotte Pålsson explains: “What is a hiatal hernia?”

If you have hiatal hernia symptoms, you may have heard many different names for your symptoms. Diaphragmatic hernia and hiatus hernia are some of the other names for hiatal hernia.

What is a diaphragm?

The diaphragm is a thin muscle that separates the heart and lungs from the stomach and the other intestines. 

Among other things, we use the diaphragm to breathe, but another important function is that it holds the stomach and its contents in place under it. 

There is a hole in the middle of the diaphragm through which the oesophagus passes down into the stomach.

Symptoms of a hiatal hernia

If you suffer from a hiatal hernia, you may experience one or more unpleasant symptoms. Symptoms can come and go and do not have to be felt every day. 

Heartburn and reflux

Heartburn and reflux are very common hiatal hernia symptoms.

The corrosive stomach acid that leaks into the oesophagus corrodes the mucous membranes and creates an unpleasant, acidic and burning sensation. Sometimes even pieces of food come back up from the stomach.


  • Reflux
  • Heartburn
  • Bouts of vomiting in which food or mucus comes up
  • Corrosive damage to your teeth

Difficulty in swallowing

Anyone who suffers from swallowing difficulties, or symptoms such as the feeling of a lump in the throat, may have difficulty understanding that it may be linked to a hiatal hernia.

But when the stomach slides up above the diaphragm, the oesophagus is also pushed upwards, which affects the swallowing function in the throat. 


  • The feeling of having a lump or cramping in the throat.
  • Obtrusive feeling in the chest.
  • That it is difficult to swallow solid and dry food. 
  • That food is stuck in your throat.
  • Feeling full up quickly.
  • A need to drink a lot to be able to swallow the food.
  • That it takes a long time to eat.

The problems can feel so difficult that you completely avoid social contexts with food and drink.

If you have swallowing difficulties it is important that you seek medical advice in order to get to the cause behind the problems and to rule out serious illnesses.

Thick phlegm, throat clearing and dry cough

It is common to have an annoying coughto clear your throat or have thick phlegm when you suffer from a hiatal hernia. This is because corrosive stomach acid has come up into the throat.

To protect the lining of the oesophagus from stomach acid, a thick phlegm is formed, which we then try to clear away when we are about to talk. Coughing, in turn, protects us from getting stomach acid on the vocal cords and in the lungs.


  • Thick phlegm in the throat
  • Large amount of frothy saliva that can be difficult to swallow
  • Prolonged cough – often in the morning
  • Throat clearing

Wind and burping

If you have a hiatal hernia, you may need to swallow a lot of saliva. It may also take a couple of attempts to swallow food. That is because your swallowing function becomes “sluggish” and food gets stuck.

Swallowing can make you feel gassy and cause you to burp a lot


  • Stomach gas
  • Excessive burping

Problems with voice and breathing

In the event of a hiatal hernia, your vocal cords are exposed to stomach acid, which can make you hoarse or, in the worst case, cause voice changes.

When the stomach slides up into the chest, it can affect other organs, such as the lungs. This can make it difficult for you to breathe properly.


  • Hoarseness.
  • Gurgly, unclear voice.
  • Voice changes
  • Breathing problems.

Pain in the stomach and other parts of the body

A hiatal hernia can cause pain in different parts of the body. For example, you may experience pain in the chest, head, back or stomach.

The chest pain can be so intense that you mistake it for a heart attack.


  • Pain in the skull behind the ear. 
  • Back pain.
  • Pain in the stomach.
  • Pain in the chest or oesophagus. The pain can be so intense that it is misinterpreted as a heart attack.

Hiatal hernia treatment

Weakened musculature is the underlying cause of symptoms such as heartburn and the feeling of a lump in the throat. Training the diaphragm is therefore the only long-term effective way to treat a hiatal hernia.

IQoro strengthens the diaphragm

IQoro strengthens the diaphragm through a simple daily routine that takes 30 seconds to perform. The efficacy of treatment has been proven in internationally published and reviewed studies.

Cleaning IQoro after training.

How does IQoro work?

When training with IQoro, you strengthen a total of 148 muscles from the mouth down to the diaphragm. During the training session, increased pressure is created in the hole in the centre of the diaphragm where the oesophagus passes through.

The increased pressure means that the diaphragm gets stronger with each workout. This means that the diaphragm is able to keep the stomach in its natural position. The stomach acid can then no longer leak into the oesophagus and cause the unpleasant symptoms.

Acid reflux treatment with IQoro
Training with IQoro. Via nerves in the lips, you train 148 muscles that are part of the swallowing process.

How do I know if IQoro is working for me? 

IQoro works equally well whether you are old, young, overweight or underweight. It has been proven by internationally published studies on the treatment of hiatal hernias.

IQoro also works regardless of whether you have had your hiatal hernia diagnosed by a doctor, or if you only suffer from symptoms suggestive of a hiatal hernia. 

Take our self-test to see if you have symptoms that can be treated with IQoro.

5.0 star rating

“I have had problems with my throat for over three years and discovered IQoro. A lot of the issues have eased significantly following 3 months of use daily, would absolutely recommend as this has been a super help to me.”

Gordon T, verified customer.

Proven efficacy in scientific studies

The efficacy of IQoro has been proven in several internationally published and peer reviewed studies published in international medical journals. The studies were carried out at Swedish universities.

The studies have shown that at least 97 per cent of people with hiatal hernia symptoms get better after six to eight months of treatment with IQoro. Most of the participants in the studies became completely symptom-free and were able to stop taking heartburn medication.

IQoro winner of the Bionow Product of the Year Award

IQoro has been awarded the prestigious Product of the Year award at the Bionow Awards held in Manchester on 7 March 2024. IQoro was the only foreign nominated entry to win the award, which according to the jury stood out for its effectiveness and ability to replace drugs and surgery.

The winning product is effective, easy to scale and can offset the need for surgery and medication so is therefore very impactful. Read more about the award

Proven efficacy in customer surveys

In our latest customer survey, we interviewed 4,400 customers who used IQoro. Of the participants, 75 per cent had already reduced or completely stopped taking medication within five months of treatment with IQoro.

This is despite the fact that a treatment period of at least six to eight months, sometimes longer, is recommended to be symptom free.

How quickly will I get better?

The duration of treatment with IQoro depends, among other things, on how long your muscles have been weakened and how regularly you train. 

According to the customer surveys that we conduct regularly, we can see that many people experience a difference in their symptoms within a couple of weeks. However, with our results guarantee, we guarantee positive changes within six months. Or, we’ll give you your money back.

The IQoro app is available in both Swedish and English. It helps you keep track of your training.

According to a scientific study published in the World Journal of Gastroenterology, all patients with a diagnosed hiatus hernia, or hiatus hernia symptoms, improved after six to eight months of training with IQoro, when training three times a day according to our instructions.

The people who participated in the study were between 19–85 years old and had experienced symptoms for 1–15 years before starting treatment with IQoro.

A rule of thumb is that the longer you have had symptoms, the longer it can take to exercise away a hiatal hernia. That is because a hiatal hernia is caused by a weakened musculature. 

It is like taking a long break from running or going to the gym.

It is therefore important to get started with the hiatal hernia treatment as early as possible to prevent more troublesome symptoms from appearing.

Other treatment methods

There are essentially two other methods of treating a hiatal hernia: antacid medication and surgery. 

  • Antacid medication is only a temporary solution that relieves your symptoms. You can read more about this in the section on symptom relief below. 
  • Surgery on a hiatal hernia is unusual and not without its risks. Find more about hiatal hernia surgery in the section at the bottom of this page.

Risks of a hiatal hernia

A hiatal hernia causes symptoms that can increase the risk of a number of serious conditions, including:

  • Swallowing problems that can cause food to get stuck in your throat.
  • A flow of stomach acid up the oesophagus that in the long-term increases the risk of cell changes and cancer.
  • Mis-swallowing that can increase the risk of pneumonia.
  • Poorer dental and oral health.
  • An incorrect load on the other muscles in the swallowing process, which in the long run can lead to problems with snoring and sleep apnoea

Important to treat quickly

When the diaphragm has become weakened, other muscles in the swallowing process need to work harder to compensate. Over time, this leads to more and more muscles becoming overworked or weakened, causing symptoms to worsen. 

Heartburn occurs more frequently, that feeling of a lump in the throat gets worse and chest pain can eventually become so bad that it feels like a heart attack. 

Therefore, to avoid the symptoms getting worse, it is important to start strengthening the muscles as soon as possible. In addition, it takes longer and longer to build up the muscles the longer you wait to start training.

My partner thought I was a hypochondriac

Magnus has always been a bii of a hypochondriac, so when food started to get stuck in his throat, his thoughts turned to cancer. He hardly thought that the solution would be a little plastic training device.

I thought that rocket salad and Parma ham would be the death of me. Read Magnus’ story

Symptom relief

IQoro treats the cause of a hiatal hernia, with scientifically proven efficacy. But it can take a few months before your training gives complete results. Therefore, it may be a good idea to relieve symptoms in other ways as well.

Here is some general advice for relieving symptoms of a hiatal hernia. But remember that the following advice will not strengthen your weakened diaphragm, it will only relieve the discomfort temporarily.  

  • Raise the head end of the bed about 15 cm. 
  • Sleep on your left side, so that the contents of your stomach do not come up into the oesophagus as easily. 
  • Change your diet – avoid foods and drinks that you know cause discomfort.
  • Drink water after each bite as you eat.
  • Avoid bending down to the floor from a standing position. 
  • Avoid heavy lifting.

Hiatal hernia treatment with medication

Some of the problems caused by a hiatal hernia can be alleviated with the help of antacid medication. There are both prescription and over-the-counter medications. Common to them is that they relieve some of the symptoms, but they do not treat the hiatal hernia itself.

However, these medications can have serious side effects when used for extended periods of time. You should therefore only use them as a temporary solution. Read more about stomach acid medications on our page about acid reflux.

Causes of a hiatal hernia

Between the lungs and the stomach is the diaphragm. It is a large, thin muscle that acts as a partition in the middle of the body.

It allows us, for example, to perform a handstand without food falling out through our mouth and our kidneys ending up by our heart.

Without a hiatal hernia. The stomach in a normal position under the diaphragm.

In the middle of the diaphragm there is a hole where the oesophagus can pass through, which is called the hiatus canal. Just below the hiatus canal, at the top of the stomach, is the lower oesophageal sphincter. 

As long as the lower oesophageal sphincter is under the diaphragm, it closes tightly upwards. Food and liquid can then make their way into the stomach, but not back up again. 

But in order for us to vomit or burp, the lower oesophageal sphincter and part of the stomach can slide up through the hole in the diaphragm to release stomach contents if necessary. 

As soon as we have finished vomiting, the stomach returns to its normal position under the diaphragm.

What happens in the event of a hiatal hernia?

In the case of a hiatal hernia, the top part of the stomach slides up into the chest cavity even when we are not vomiting. This is because the diaphragm’s muscles are weakened and cannot hold the stomach in place.

The stomach then slides uncontrollably up and down through the diaphragm and can remain in the chest cavity for a long time. And since the lower oesophageal sphincter cannot tighten when it is above the diaphragm, stomach acid begins to leak into the oesophagus. 

With a hiatal hernia. Part of the stomach is above the diaphragm.

The corrosive stomach acid then causes discomfort in the form of heartburn, acid reflux etc. 

In addition, the oesophagus is affected by the stomach pressing upwards. It folds like an accordion, which can cause pain and that food can get stuck on the way down the stomach.

The stomach has slid up above the diaphragm. The upper oesophageal sphincter does not open when swallowing as the oesophagus is folded.

Stomach acid leaks out

When stomach acid leaks into the oesophagus, it is called reflux,it is also called gastroesophageal reflux disease or GERD/GORD. The acid causes a number of different problems.

A hiatal hernia causes stomach acid to leak uncontrollably into the oesophagus.

It corrodes the oesophagus and if it reaches the mouth, can cause corrosive damage to teeth. Other symptoms include bad breath, cough, heartburn, acid reflux and nausea.

When stomach acid leaks up, thick phlegm forms. This is because the oesophagus creates a thick phlegm to protect the mucous membranes from the corrosive stomach acid.

The stomach that has slipped up into the chest displaces other organs, such as the lungs and heart. It can cause pain across the chest that can sometimes be perceived as so severe that it is misinterpreted as a heart attack.

Hiatal hernia in children

Children with a hiatal hernia may have difficulty swallowing. The child then often refuses to eat certain foods, which can be misinterpreted as food refusal.

At about six months of age, the child’s oesophagus usually begins to increase in length. At about 12 months, the stomach has usually ended up in the right place under the diaphragm.

In some children, however, the lower oesophageal sphincter remains above the diaphragm causing the same symptoms as in adults with a hiatal hernia.

The hernia can cause children to decline dry and solid food but accept fluids.

Do you always find swallowing food difficult?

Do you experience an obstructive sensation in your chest when swallowing food of a certain size? This can be due to, for example, a tumour, scarring or pockets along the oesophagus. This is known as chronic dysphagia.

If you think you have chronic dysphagia, you should contact your medical healthcare centre and ask for a referral to a specialist doctor – surgeon or gastroenterologist.

Achalasia or hiatal hernia

In some cases, a hiatal hernia can be confused with other diseases. One example is the rare oesophageal disease achalasia cardiae

If you have been examined for achalasia and have been diagnosed with achalasia cardiae, you should only start treatment with IQoro on your doctor’s advice and with careful follow-up. 

However, there are people who have been told by healthcare professionals that they may have achalasia, but where the diagnosis of achalasia cardiae has not been established. In these cases, achalasia and hiatal hernia may have been confused. 

Differences between achalasia cardiae and a hiatal hernia

  • In achalasia, the patient always has difficulty swallowing food of a certain size.
  • In the case of a hiatal hernia, swallowing problems occur in intervals or with different sizes of food.
  • In achalasia, the patient never has heartburn and acid reflux
  • In the case of a hiatal hernia, the patient may experience heartburn and acid reflux.
  • In achalasia, the patient loses weight quickly.
  • In the case of a hiatal hernia, there is no direct weight loss.
  • In achalasia, pneumonia is common.
  • In the case of a hiatal hernia, pneumonia is rare.

If you suspect that you have suffered from achalasia cardiae, you should seek medical attention as soon as possible for examination.

Läs mer under Akalasi (Achalasia cardiae).

Seeking help

A hiatal hernia is common and can cause problems that affect your everyday life. Since an untreated hiatal hernia can worsen, it is a good idea to start treating it at an early stage.

When should I seek medical help?

If you have problems that indicate a hiatal hernia, we recommend that you contact your medical healthcare centre. Your doctor can then rule out other more serious diseases.

You can start treating your problems with IQoro while waiting for an appointment for examination. IQoro does not cause any negative side effects and can therefore be used without risk except in a few rare cases.

Contact your medical healthcare centre if the symptoms of a hiatal hernia worsen quickly. Do you have heartburn as well as black stools, or when vomiting bring up something that looks like coffee grounds? Then you should go to a medical healthcare centre or A&E as soon as possible.

Examinations and investigations

If you seek treatment for a hiatal hernia, you will most likely be examined by a doctor at your medical healthcare centre. You will then have to describe your problems. Therefore, it may be a good idea to consider the following questions before your doctor’s visit: 

  • How often do you experience your symptoms?
  • How long have you had the symptoms?

Feel free to do our self-test for a hiatal hernia to see if you have one or not. The test only takes three minutes and is completely free.

Gastroscopy in the event of a hiatal hernia

When seeking help for hiatal hernia symptoms, doctors might want to perform a gastroscopy. A camera is then inserted through the nose to examine the mucous membrane of the oesophagus and stomach. It can also be done to take a tissue sample. 

However, a hiatal hernia is not always visible during a gastroscopy. The stomach may temporarily slide back down under the diaphragm at the time of the examination.

The gastroscopy is mainly performed to rule out other diagnoses – not specifically to see if you have a hiatal hernia.

Surgery for a hiatal hernia

Surgery for a hiatal hernia is a treatment in which the hernia is compensated by a surgical procedure. However, it is both risky and awkward and is therefore only offered in a few cases where no other treatment methods work.

Hiatal hernia surgery involves sewing up the upper part of the stomach, which means that it can no longer slide up above the diaphragm. However, surgery does not improve the strength of the diaphragm.

After surgery, you will no longer be able to burp or vomit. You will therefore need healthcare assistance when you need to empty your stomach. This is done by inserting a catheter (a tube-shaped instrument) into the stomach and through it the contents are then emptied. Research shows that training with IQoro is a simple, risk-free and cost-effective treatment that can prevent the need for hiatal hernia surgery.


  1. Kjellén G, Tibbling L. Manometric oesophageal function, acid perfusion test and symptomatology in a 55-year-old general population. Clinical Physiology. 1981; 1:405-15
  2. Hägg M, Tibbling L, Franzén T. Esophageal dysphagia and reflux symptoms before and after oral IQoro® training. World J Gastroenterol 2015; 21(24): 7558-7562.
  3. Hägg M, Tibbling L, Franzén T. Effect of IQoro® training in hiatal hernia patients with misdirected swallowing and esophageal retention symptoms. Acta Otolaryngol. 2015 Jul; 135 (7):635-9. 
  4. Nin CS, Marchiori E, Irion KL, Paludo Ade O, Alves GR, Hochhegger DR, Hochhegger B. Barium swallow study in routine clinical practice: a prospective study in patients with chronic cough. J Bras Pneumol 2013; 39: 686-691 [PMID: 24473762 DOI:10.1590/S1806-37132013000600007]
  5. Tibbling-Grahn L, broschyr 03 Svenska Dysfagiförbundet, Stoppar maten upp i bröstet när du äter? Mellangärdesbråck – En vanlig matstrupssjukdom i alla åldrar.

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