About Hiatal Hernia
A hiatal hernia is a condition in which all or part of the stomach is in the chest rather than in the abdomen. Normally, the esophagus passes through the diaphragm into the abdomen at an opening in the diaphragm called the esophageal hiatus. The esophagus is anchored by ligaments at the hiatus and the hiatus is small, so the stomach remains in the abdomen. If the opening enlarges or the ligaments give way, the stomach can move into the chest, resulting in a hiatal hernia.
Two types of hiatal hernia:
Sliding hernias are the most common; about 50% of people 50 years of age or older have one. Sliding hernias usually don't cause problems, but they are associated with reflux. Only sliding hernias associated with significant reflux symptoms, those which cause symptoms because of their size (difficulty breathing), or those that cause bleeding should be considered for surgical repair.
Paraesophageal hernias are more dangerous and much less common than the sliding variety. The esophagus remains anchored, but the stomach moves up through the opening in the hiatus and into the chest. This rolling movement of the stomach into the chest puts the stomach at risk for twisting in the chest (volvulus) which can cause an obstruction. Since this can be life threatening, all paraesophageal hernias should be surgically corrected once they are diagnosed, regardless of symptoms.