Esophageal hiatal hernia is a condition caused by the passage of intra-abdominal organs, mainly the stomach, into the thoracic cavity through the diaphragmatic esophageal hiatus. Esophageal hiatal hernia is the most common of diaphragmatic hernias, accounting for more than 90% of cases. Patients with esophageal hiatal hernia can be asymptomatic or mildly symptomatic, and the severity of their symptoms is independent of the size of the hernia sac and the severity of esophageal inflammation. Hiatus hernia and reflux esophagitis can coexist or exist separately. The disease can occur at any age, but the onset of symptoms increases with age. The incidence of this disease in the general population survey is 0.52%, while the detection rate of sliding esophageal hernia is 11.8% in routine gastrointestinal X-ray barium meal examinations of people with suspected symptoms of hiatal hernia. In recent years, the detection rate can reach 80% by using special body pressure method during X-ray examination. Since the disease is mostly asymptomatic or mildly symptomatic, it is difficult to derive its exact incidence. The disease is more common in women than in men, 1.5 to 3:1. Etiology: 1. Congenital factors of esophageal dysplasia. 2, structure of the esophageal cleft site, such as muscles with atrophy or weakened muscle tone. 3, Acquired factors of long-term increased abdominal pressure, such as pregnancy, pneumoperitoneum, chronic cough, habitual constipation, etc. can cause the body of the stomach to herniate above the diaphragm and form an esophageal hiatal hernia. 4. Post-surgical hiatal hernia, such as surgery on the upper part of the stomach or the cardia, can also cause hernia by destroying the normal structure. Clinical manifestations: 1. Gastroesophageal reflux symptoms: Burning sensation behind the sternum or under the glabella, regurgitation of gastric contents, epigastric fullness, belching, pain, etc. The nature of pain is mostly burning or pins-and-needles pain, which can radiate to the back, shoulders, neck, etc. The symptoms may be triggered and aggravated by lying down, eating sweet and acidic foods. This symptom is especially common in sliding hiatal hernia. Complications (1) Bleeding hiatal hernia can sometimes bleed, mainly due to esophagitis and herniorrhaphy, and is mostly chronic with a small amount of oozing blood, which can lead to anemia. Ulceration of the herniated stomach and intestine may lead to vomiting of blood and black stool. (2) Reflux esophageal strictures occur in a small number of patients with reflux symptoms, resulting in dysphagia, painful swallowing, and vomiting after eating. (3) Hernia sac impaction is usually seen in paraesophageal hernia. Patients with hiatal hernia who have sudden severe epigastric pain with vomiting, complete inability to swallow or simultaneous hemorrhage suggest acute intussusception. When the hernia sac is large and compresses the heart, lungs and mediastinum, it can produce symptoms such as shortness of breath, palpitation, cough and cyanosis. When the esophagus is compressed, food stagnation or difficulty in swallowing can be felt behind the sternum. Treatment: 1. Internal treatment is suitable for small slip hernia and those with mild reflux symptoms. The main principles of treatment are to eliminate the factors of hernia formation, control gastroesophageal reflux, promote esophageal emptying and moderate or reduce gastric acid secretion. (1) Lifestyle changes ① Reduce the amount of food, mainly high protein and low fat diet, avoid coffee, chocolate, alcohol, etc. Avoid lying down after meals and eating before sleep. (2) Take the head high and foot low position when sleeping, and elevate the head of the bed when lying down. ③Avoid bending, wearing tight clothes, vomiting and other factors that increase intra-abdominal pressure. ④Obese people should try to reduce their weight, and those with chronic cough and long-term constipation should try to treat them. For asymptomatic esophageal hiatal hernia and small hiatal hernia, the above treatment can be given appropriately. (2) Drug treatment For those who already have gastroesophageal reflux symptoms such as chest pain, retrosternal burning, acid reflux or postprandial regurgitation, in addition to the above preventive measures, anti-reflux and protective drugs for esophageal mucosa and prokinetic drugs should be given. Surgical treatment (1) Indications for surgery (1) Esophageal hiatus hernia combined with reflux esophagitis, the effect of medical treatment is not good. (2) Esophageal hiatal hernia with pyloric obstruction and duodenal stasis. ③Para-esophageal hiatal hernia and giant hiatal hernia. (4) Esophageal hiatal hernia with suspected cancer. (2) Surgical principles ①Reset the contents of the hernia. ②Repair the loose and weak esophageal hiatal hernia. (3) Prevention and control of gastroesophageal reflux. ④Keep the gastric outflow tract unobstructed. ⑤Treat coexisting complications. (3) There are many surgical methods for the treatment of esophageal hiatus hernia, mainly hernia repair and anti-reflux surgery.