Dysphagia, ptyalism, vomiting and regurgitation are common clinical signs in brachycephalic breeds. Prevalence of gastrointestinal disease in brachycephalic dog populations, especially in the French bulldog, has been reported to be as high as 97%. The negative intrathoracic pressures generated by increased inspiratory effort is believed to be a major cause of the gastro-oesophageal reflux. Laxity of the phreno-oesophageal ligament and the presence of a sliding hiatal hernia are also recognised in the many brachycephalic breeds. The necessity of making a definitive diagnosis of a sliding hiatal hernia is controversial; in part, because the dynamic nature of the condition means that often it is not an easy diagnosis to make. Most commonly, regardless of the diagnosis of a sliding hiatal hernia, the gastrointestinal signs are managed medically (for example, with the administration of a proton-pump inhibitor, a gastric protectant omeprazole and the use of an appropriate feeding regime) and, surgically, with the improvement of airway function. This presentation explores the controversies, while providing a practical and rationale approach to a typical case. In addition, the surgical management options for non-responsive cases are considered.