Other nonneoplastic

Hiatal hernia

Topic Completed: 1 November 2012

Minor changes: 16 December 2020

Copyright: 2003-2021,, Inc.

PubMed Search: Hiatal hernia[TI] esophagus[TI]

Elliot Weisenberg, M.D.
Page views in 2020: 1,341
Page views in 2021 to date: 1,140
Cite this page: Weisenberg E. Hiatal hernia. website. Accessed October 22nd, 2021.
Definition / general
  • Due to separation of diaphragmatic crura and widening of space between muscular crura and esophageal wall (eMedicine: Hiatal Hernia [Accessed 15 February 2019], eMedicine: Hiatal Hernia Imaging [Accessed 15 February 2019], Wikipedia: Hiatus Hernia [Accessed 15 February 2019])
  • Associated with reflux esophagitis, both erosive and nonerosive (BMC Gastroenterol 2005;5:2)
  • May be axial or nonaxial:
    • Axial (sliding): 95%, protrusion of stomach above diaphragm creates bell shaped dilation
    • Nonaxial (paraesophageal): 5%, separate portion of stomach enters thorax, usually along greater curvature; may be due to surgery for sliding hernias but cause often unknown, associated with reflux but compromise of LES is probably due to the hernia
    • Only 9% with sliding hernias have heartburn or regurgitation of gastric juices into the mouth; accentuated by bending forward, lying supine, obesity
  • Complications: ulceration, bleeding, perforation; strangulation of paraesophageal hernias; increased risk of esophageal and gastric adenocarcinoma (Cancer 2003;98:940)

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Axial (sliding) hernia

Nonaxial (paraesophageal) hernia

  • Incidence: 1 - 20% of adults, increases with age, also seen in children
Case reports
Clinical images

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Axial (sliding) hernia / autopsy findings

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