Hiatus Hernia
Under normal circumstances the junction between the bottom end of the gullet (oesophagus) and the top of the stomach (called the gastro-oesophageal junction or GOJ) is at the level of the breathing muscle or diaphragm at the bottom of the rib cage. In some people the GOJ is above the diaphragm and therefore in the chest: the stomach has been pushed (or herniated) through the opening (or hiatus) in the diaphragm. As a result of this disruption of the normal muscular barrier, acid produced by the stomach may move more freely into the lower oesophagus leading to GORD (see Gastro-oesophageal reflux disease).
Most patients with a hiatus hernia respond to life-style measures such as weight loss and eating smaller meals more frequently or taking a drug called a proton pump inhibitor, such as omeprazole. Occasionally surgery may be required to correct the mechanical defect.