by Nicole Evans M.D.

Created on: May 31, 2009   Last Updated: February 09, 2010

Hiatal hernias are surprisingly common in elderly and obese individuals and are frequently misdiagnosed as gastroesophageal reflux disease (GERD). There are actually two main types of hiatal hernias, a sliding hiatal hernia and a paraesophageal hiatal hernia.

Understanding difference between these two types of hiatal hernias requires a quick anatomy review:

When food is swallowed it travels from the mouth, through the upper part of the throat (called the pharynx), down the muscular tube of the esophagus, and into the stomach. Food is allowed to pass from the esophagus into the stomach by the relaxation of the lower esophageal sphincter.

The esophagus has to pass through the diaphragm that separates our chest cavity from our abdominal cavity. The esophagus passes through an opening in the diaphragm called a hiatus so that the lower esophageal sphincter sits, along with the stomach, right underneath the diaphragm.

The difference between sliding hiatal hernias and paraesophageal hernias depends on exactly what is abnormally protruding through the hiatus of the diaphragm:

Sliding Hiatal Hernia

This type of hiatal hernia occurs when the lower muscular sphincter of the esophagus that normally allows food to pass into the stomach becomes displaced. The lower esophageal sphincter slides up through the opening (or hiatus) of the diaphragm.

When the lower esophageal sphincter is sitting above the diaphragm, rather than under it, it can no longer function properly and food gets backed up. Sliding hiatal hernias can cause dysphagia (difficulty swallowing), heart burn, pain, and regurgitation of food.

Rolling Hiatal Hernia

This type of hiatal hernia is also called a paraesophageal hernia. A rolling hiatal hernia occurs when a bit of the stomach gets squeezed up through the diaphragmatic hiatus against the esophagus. This compresses the esophagus and lower esophageal sphincter so that the sphincter can't work right and, once again, food gets backed up causing regurgitation, reflux of stomach acid, and/or difficulty swallowing.

The rolling type of hiatal hernia is more dangerous than a sliding hiatal hernia because the entire stomach, and even part of the small intestines, could herniate through and occupy the pleural space where the lungs are supposed to expand.

Another dangerous possibility is that the part of the GI tract that is protruding through the diaphragmatic hiatus develops a compromised blood supply and begins to die off. Thus, it is important to work with your physician to have your hiatal hernia properly diagnosed and treated.

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