Describe the relationship and types of hiatus hernia in the development of reflux. Types of Hiatus Hernia Sliding Hital Hernia (Type I) Most common type – 95% of cases. The gastroesophageal junction and the gastric cardia slide up into the posterior mediastinum. The gastric fundus remains below the diaphragm (hourglass stomach). Clinical Features: heartburn, regurgitation and chest pain. Paraesophageal Hital Hernia (Type II) Part of the gastric fundus herniates into the thorax. The GEJ remains in its anatomical position below the diaphragm. Clinical features: Clinical features: strangulation of the herniated stomach (complication) -> severe pain, early satiety, GERD symptoms, epigastric and/or substernal pain Mixed Hital Hernia (Type III) Combination of types I and II. Clinical features: mixture of the above. Complex Hital Hernia (Type IV) Rare Herniation of the stomach, EGJ, and other abdominal organs such as colon, sleeping, pancreas into the chest cavity. Clinical features: due to involvement of multiple organs -> severe symptoms. Pathophysiology Diagnostics Barium swallow enema Most sensitive Used to evaluate size and type Endoscopy Evaluated size and types Assesses for complications such as Barrett’s oesophagus The location of the GEJ junction is determined using the Z-line (squamocolumnar junction). X-Reay Typical incidental findings -> retrocardiac soft tissue with or without air fluid levels