Sliding hiatal hernias are the most common. They occur when part of the stomach bulges through the diaphragm and into the chest cavity when a person swallows food. The hernia actually slides back and forth between the abdominal and chest cavities.
Sliding hiatal hernias usually do not cause symptoms and do not require treatment.
When symptoms do occur, their treatment is the same as for GERD.
Para-esophageal hernias are the least common. They occur when part of the stomach bulges into the chest cavity and stays there all the time. A large para-esophageal hernia may make it difficult for food to pass normally into the stomach. In addition, ulcers may form in the herniated part of the stomach.
Surgery is the treatment for large para-esophageal hernias. During the operation, the surgeon moves the herniated area of stomach back into the abdominal cavity. He then tightens the esophageal hiatus, making it smaller so the stomach can no longer bulge through. Finally, he makes sure that the esophagus is firmly attached to the diaphragm.