Hiatus Hernia
Widening of the diaphragmatic oesophageal hiatus lets part of the stomach migrate into the thorax, and whether it drags the gastro-oesophageal junction upward with it (sliding, disrupting the reflux barrier) or herniates alongside a normally sited junction (rolling, risking obstruction and strangulation) determines both the symptoms and the urgency.
In a nutshell
A sliding hiatus hernia drags the gastro-oesophageal junction and lower oesophageal sphincter above the diaphragm, disabling the reflux barrier, hence heartburn. A rolling hiatus hernia leaves the junction in place but herniates the fundus alongside it, so reflux is often absent but obstruction and strangulation are the danger instead.
Classic presentation
Heartburn and regurgitation worse on lying flat, or, in a rolling hernia, vague postprandial fullness and bloating with little reflux, occasionally presenting acutely with severe chest pain and retching without vomiting.
Key points
- Sliding hernia (~95%) moves the GOJ and sphincter above the diaphragm, causing reflux; rolling hernia leaves the GOJ in place and herniates the fundus alongside it.
Educational content pending clinical review. Not medical advice.