Hiatal Hernia

A hiatal hernia is movement of part of the stomach through the esophageal opening of the diaphragm into the thorax. The lower esophageal sphincter and the surrounding crural diaphragm normally work together as an antireflux barrier. When the gastroesophageal junction moves above the diaphragm, the crural "pinch" no longer supports the sphincter in its usual position. Reflux becomes more likely, but a hiatal hernia and gastroesophageal reflux disease (GERD) are not the same diagnosis: either can occur without the other. Hiatal hernias are classified by the structures above the hiatus: - Sliding: the gastroesophageal junction is above the hiatus. This form is most closely associated with reflux. - Paraesophageal: the gastric fundus herniates beside the esophagus while the gastroesophageal junction remains in its usual position. - Mixed: both the gastroesophageal junction and stomach are above the hiatus. - Complex: the hernia includes stomach and another abdominal organ. The distinction predicts the main problem. A sliding hernia usually presents through reflux symptoms or is found incidentally. A paraesophageal hernia can distort or compress the stomach and may cause postprandial fullness, dysphagia,...