A sliding hiatal hernia often is diagnosed when a person is being evaluated for another health concern. If you go to the doctor with a feeling of burning, warmth, heat, or pain behind the breastbone (often known as heartburn), your doctor will probably ask you questions about your symptoms and may want to do other tests if any of the following are true:

• You have had heartburn symptoms for a long time.
• Your symptoms do not get better with medication.
• Your symptoms promptly come back after medication is stopped.
• Other serious signs or symptoms are present, such as weight loss, vomiting of blood, or difficulty swallowing.

If you have symptoms and any of the above are true, you probably have gastroesophageal reflux disease (GERD). Hiatal hernia and GERD often occur together. If this is the case, your doctor may do more specific tests to confirm a diagnosis. For more information, see the topic Gastroesophageal Reflux Disease (GERD).

Your doctor may find a hiatal hernia while doing a test called an upper gastrointestinal series. This test examines the upper and part of the middle portions of the digestive tract. After you swallow a "shake" made of barium and water, X-rays are taken to track the movement of the barium through the esophagus, the stomach, and the first part of the small intestine (duodenum) using fluoroscopy connected to a video monitor. See an illustration of a fluoroscopic image of a hiatal hernia.

Upper gastrointestinal endoscopy is a procedure that allows your doctor to look at the interior lining of your esophagus, stomach, and duodenum by using a thin, flexible imaging instrument called an endoscope. This procedure is commonly used to diagnose hiatal hernia.

If you have shortness of breath or pain in the area of your breastbone, you need to make sure it is not caused by a heart problem. The burning sensation caused by GERD usually occurs after eating. Pain from your heart is usually felt as pressure, heaviness, a weight, tightness, squeezing, discomfort, or a dull ache that occurs most often after activity. To learn more about chest pain that may indicate problems with your heart, see the topic Chest Pain.