Pathogenesis (development of disease)
In hiatal hernia, insufficiency of the diaphragm (weakness of the diaphragm) in the area of the esophageal hiatus (opening in the diaphragm through which the esophagus passes with the two vagus nerves) causes displacement of the stomach, which is usually partial but may be complete.
The following forms can be distinguished:
- Axial hernia (sliding hernia): displacement of cardia (gastric inlet) and fundus parts (“base of the stomach“) into the thorax/chest cavity.
- Cardiofundal malposition
- Paraesophageal hiatal hernia: displacement of fundal parts past the esophagus (= paraesophageal) into the thoracic cavity; normal position of the cardia (extreme: upside-down stomach; upside-down stomach).
Etiology (causes)
Biographical causes
- Increased age
- Connective tissue insufficiency (connective tissue weakness)
Behavioral causes
- Overweight (BMI ≥ 25; obesity).
Disease-related causes
- Pressure increase in the abdomen (abdominal cavity), as occurs in obesity (obesity), chronic constipation (constipation) or tumors in the abdomen.
