Epidemiology

Etiology

• Lax diaphragmatic esophageal hiatus
  • Advanced age
  • Smoking
    • Causes a loss of elastin fibres in the diaphragmatic crura
  • Obesity
• Prolonged periods of increased intra-abdominal pressure
  • Pregnancy
  • Ascites
  • Chronic cough
  • Chronic constipation

Pathophysiology

Relative negative intrathoracic pressure and the lax hiatus → herniation of the abdominal contents into the thorax → loss of reflux barrier + compromised fluid emptying of distal esophagus → gastroesophageal reflux disease (GERD)

Classification

Type I: sliding hiatal hernia

• Most common type (95% of cases)
• The GEJ and the gastric cardia slide up into the posterior mediastinum.
• The gastric fundus remains below the diaphragm (hourglass stomach)

Type II: paraesophageal hiatal hernia

• Part of the gastric fundus herniates into the thorax.
• The GEJ remains in its anatomical position below the diaphragm.

Clinical features

Diagnostics

Treatment