Esophageal Hernias

Hiatal hernias come in a variety of forms and are often asymptomatic, but may also present with heartburn, regurgitation, chest pain, and dysphagia. The causes are often unknown. Sliding, aka, Type 1 hernias make up 95% of cases. They occur when the gastroesophageal junction and a portion of the stomach herniate into the thoracic cavity. Sliding hernias can cause GERD and aspiration, and are usually treated with proton-pump inhibitors. Paraesophageal hernias (types 2-4) are true hernias in which a sac protrudes above the diaphragm. The specific type is determined by the location of the gastroesophageal junction and which segments have herniated; Type 4 involves herniation of the stomach and other organs. Complications of paraesophageal hernias include obstruction, hemorrhage, and strangulation; thus, they are potentially life-threatening and require surgical treatment.