Gastric reflux is common in up to 20 to 30% of obese patients who are also likely to have a hiatal hernia. Some of the cases are asymptomatic. We have a special wall that prevents stomach acid from entering. The diaphragm is the muscle lining that prevents stomach acid pressure from rising upwards into the esophagus typically during or after meals. In acid reflux, the esophagus pulls the stomach through the diaphragm which can be painful and difficult to manage. This reflux worsens the hiatal hernia over time.