Definition

Protrusion of any abdominal structure/organ into the thorax through a lax diaphragmatic esophageal hiatus. (In 95% of cases, a portion of the stomach is herniated.)

• Incidence increases with:

  • Age: affects ∼ 70% of people > 70 years

  • ↑ BMI

• Prevalence

  • More prevalent in females and Western populations [1]

  • Most commonly occur on the left side, as the liver protects the right diaphragm.

The etiology is multifactorial.

• Lax diaphragmatic esophageal hiatus

  • Advanced age

  • Smoking

  • Obesity

  • Genetic predisposition (rare) [2]

• Prolonged periods of increased intra-abdominal pressure

  • Pregnancy

  • Ascites

  • Chronic cough

  • Chronic constipation [1]

• Defects of the pleuroperitoneal membrane