Hiatus Hernia and Gastroesophageal Reflux Disease

Over the past decades, the views on the role of hiatus hernia in the pathophysiology of gastroesophageal reflux disease (GERD) have varied considerably. Around 1950, radiographic studies (barium swallows) had shown that the prevalence of hiatus hernia in patients with reflux disease was high, and at one point GERD was almost considered synonymous with hiatus hernia. Sliding hiatal hernias and paraesophageal hernias are believed to be acquired during life, but there are also congenital hernias. Symptomatic congenital diaphragmatic hernias appear in 1 in 2000 births, but asymptomatic defects are far from rare in adults. There are several techniques with which a hiatus hernia can be detected, in particular barium esophagogram, upper endoscopy, and high-resolution manometry. In addition, high-resolution manometry and topographical pressure plots have made it possible to visualize the manometric morphology of the esophagogastric junction during routine clinical function testing.