Eight cases of symptomatic hiatal hernia were investigated; four presented with respiratory symptoms simulating chronic asthmatic bronchitis or bronchopneumonia. Among 27 patients with gastro-oesophageal reflux but without radiologically visible hernia, six presented with fibrous stricture; no stricture was found in association with hiatal hernia. It is suggested that patients with gastro-oesophageal reflux should be offered surgical follow-up or surgery to prevent the development of a stricture before the more easily recognizable symptoms of heart burn and postural acid regurgitation get worse.