A hiatal hernia, also known as a hiatus hernia, is a portion of the upper part of the stomach protrudes into the chest through a weakened area or tear in the diaphragm.

Hiatal hernias generally fall into two different categories, sliding or para-esophageal. A sliding hiatal hernia, the most common type, occurs in the spot between the esophagus and stomach causing the stomach to protrude into the chest. The portion of the stomach may remain in the chest or jut into the chest during a swallow.

This action occurs because with each swallow the esophagus contracts causing it to shorten and draw up the stomach. Once the swallow finishes the herniated portion of the stomach will drop back into the abdominal cavity.

Para-esophageal hernias also occur at the junction of the esophagus and stomach with the area remaining in place at the level of the diaphragm, but part of the stomach bulges or passes into the chest beside the esophagus. This type of hernia will remain in the chest at all times and is not affected by the swallowing process.

If a Para-esophageal hernia is large enough to compress the esophagus, it may block the passage of food into the stomach or cause food to become lodged in the esophagus after it is swallowed. Although rare, para-esophageal hernias may become complicated by ulcers forming caused by the lodged food or stomach acid.

The greatest percentage of hiatal hernias are of the sliding variety and are generally a symptomatic. If a sliding hiatal hernia enlarges it may begin to present symptoms similar to those of gastroesophageal reflux disease or as its better-known acronym, GERD.

These symptoms include acid reflux, pain similar to heartburn, and regurgitation, cause by the stomach acid refluxing back into the esophagus. Much like with cases of GERD, this refluxed acid can cause damage to the lining of the esophagus which can lead to other more serious health issues like esophageal ulcers and possibly even esophageal cancer in older patients. The hiatal hernia may also worsen the symptoms of GERD suffers

There are a number of potential causes of a hiatal hernia. Among those most often cited are actions that cause an increase in pressure within the abdomen like heavy lifting, frequent bending, a hard or frequent cough or sneeze, straining with constipation, or an episode of violent vomiting. Obesity is also a contributing factor, with the strain and pressure of carrying extra weight causing the stomach to expand or bulge.

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