(See also Overview of Esophageal and Swallowing Disorders.)
Hiatus hernia is a protrusion of the stomach through the diaphragmatic hiatus. Most hernias are asymptomatic, but an increased incidence of acid reflux may lead to symptoms of gastroesophageal reflux disease (GERD). Diagnosis is by barium swallow. Treatment is directed at symptoms of GERD if present.
In a sliding hiatus hernia (the most common type), the gastroesophageal junction and a portion of the stomach are above the diaphragm. In a paraesophageal hiatus hernia, the gastroesophageal junction is in the normal location, but a portion of the stomach is adjacent to the esophagus in the diaphragmatic hiatus. Hernias may also occur through other parts of the diaphragm (see Diaphragmatic Hernia).
A sliding hiatus hernia is common and is an incidental finding on x-ray in > 40% of the population; therefore, the relationship of hernia to symptoms is unclear. Although most patients with GERD have some degree of hiatus hernia, < 50% of patients with hiatus hernia have GERD.