Esophageal hiatal hernia is mostly caused by widening of the esophageal fissure, which can be congenital, but is more often caused by ageing, atrophy of the diaphragmatic esophageal membrane elastic tissue and loosening of the peresophageal ligament. Pregnancy, obesity, massive ascites, huge intra-abdominal tumors, chronic constipation and violent coughing can all increase the abdominal pressure and induce a hiatal hernia. In addition, esophageal shortening caused by inflammation, ulcer, tumor infiltration and surgery can also cause esophageal hiatal hernia. The common clinical manifestations are: (a) gastroesophageal reflux symptoms manifested as retrosternal pain, heartburn, acid reflux, regurgitation, epigastric fullness, belching and so on. The pain can be mild or severe, and in severe cases it is unbearable and can radiate to the neck, ear, upper chest, back, left shoulder and right shoulder. The symptoms may be triggered or aggravated by lying down, bending over, eating alcoholic and acidic foods, coughing, and fullness, and can be relieved by standing up or belching. (2) Symptoms of hernia sac compression When the hernia sac is large, it compresses the heart, lungs and mediastinum, which may produce symptoms such as chest tightness, shortness of breath, palpitation, cough, cyanosis and even syncope. When compressing the esophagus, it may feel a feeling of eating stagnation or difficulty in swallowing behind the sternum. (iii) Complication symptoms 1. Upper gastrointestinal bleeding: hiatal hernia with bleeding is mainly caused by esophagitis and hernia bursitis, mostly chronic with a small amount of oozing blood, manifested only as black stool, which may lead to anemia. In combination with severe esophagitis or esophageal or gastric ulcer, violent vomiting of blood may occur. 2. Perforation: In rare cases, the ulcer in the hernia sac can be perforated, manifesting as severe chest pain and shortness of breath, with a poor prognosis if it ruptures into the pleural or pericardial cavity. About 74% of gastric ulcers in diaphragmatic hernia are complicated by upper gastrointestinal bleeding, but perforation is rare, only about 7%. 3. Esophageal obstruction: The main manifestations are dysphagia, painful swallowing, and vomiting after eating, caused by esophagitis resulting in esophageal spasm or organic scarring stenosis. In patients with reflux symptoms, about 10-15% of organic esophageal strictures occur. 4. Hernia sac twisting and entrapment: rare. Larger paraesophageal hernias are prone to torsion or impaction because the fundus and body of the stomach herniate into the thoracic cavity, while the cardia of the stomach is below the diaphragm. It presents as sudden severe epigastric pain with vomiting, complete inability to swallow or simultaneous hemorrhage, and there is a risk of shock and death if not treated in time, and emergency surgery should be performed. 5, esophageal coronary syndrome: the pain of esophagus in this disease can stimulate the vagus nerve and reflexively cause insufficient coronary artery blood supply, the electrocardiogram shows myocardial ischemic changes, the patient can have chest tightness, pressure in the precordial area, arrhythmia and other manifestations. The patient may experience chest tightness, pressure in the precordial region, and arrhythmia. The disease may be triggered or aggravated by pre-existing coronary heart disease. In the absence of complications, there are usually no special signs of esophageal hiatal hernia, and a bulbar and turbid zone can be percussed in the chest in giant hernias. Bowel sounds and splashing sounds can be heard in the chest after drinking or during vibration, and some patients have sternal or subxiphoid pressure pain. Patients with esophageal hiatal hernia are prone to develop symptoms associated with gallstone disease, chronic cholecystitis, peptic ulcer and intestinal diverticulosis.