The esophagus passes through an opening in the diaphragm (i.e. esophageal hiatus) as it courses through the chest to the abdomen eventually ending at the stomach. This opening is usually adequate for passage of the esophagus and nothing else. However, patients that have a hiatal hernia have an enlarged opening. There are four different types of hiatus hernias described. A sliding hernia is the most common of the four representing more than eighty percent of all hiatus hernias. The lower esophageal sphincter- the high-pressure zone near the junction of the stomach and esophagus- fails and allows stomach contents to reflux into the esophagus.


The symptoms associated with hiatal hernia are variable but generally include:

  • Heartburn – 30 – 60 minutes after eating
  • Regurgitation – worsened with lying flat
  • Excessive belching
  • Aspiration – stomach contents refluxed into the airway
  • Asthma – a chronic result of aspiration
  • Chest pain – burning mid-chest pain
  • Difficulty swallowing
  • Pain with swallowing
  • Bleeding
  • Stomach twisting and perforation