sliding and rolling (para-esophageal). Of all the diaphragmatic hernias, both congenital and acquired,
most commonly encountered.
phrenoesophageal ligament, from which a dilation of the esophageal hiatus ensues.
slide/glide into the thoracic cavity, with a consequent apparent loss of the cardiac notch and a downward displacement of the physiologic inferior esophageal sphincter.
change of body position (reclining), in response to the suction effect of each inspiratory movement, or with filling of the stomach.
adhesions may form which fix the hernia in place. The disease may remain symptomless for many years and may be discovered only accidentally during the search for the cause of a variety of epigastric symptoms, usually produced by an accompanying reflux esophagitis (inflammation of the esophageal mucosa due to the regurgitation of gastric acid). The diagnosis is readily established by adequate radiographic examination (putting the patient into the head-down Trendelenburg position may be necessary) and esophagoscopy, which, in particular, is able to confirm the reflux phenomenon.
weakened LES, abnormally large esophageal hiatus, increased intra-abdominal pressure(chronic cough, straining, constipation, obesity, pregnancy, vomiting).