Gastroesophageal reflux disease, hiatal and diaphragmatic hernias

1. Big picture

This topic links a functional disease (GERD) with an anatomical defect (hiatal hernia) — they share the same weak point, the oesophageal hiatus of the diaphragm.

Competent antireflux barrier  → acid stays in the stomach
Incompetent barrier (± hiatal hernia)  → reflux → GERD → complications
Large defect at the hiatus  → stomach migrates into the chest (hiatal hernia)
                            → at the extreme: gastric volvulus / strangulation

For the oral exam, three threads run through everything:

GERD is usually treated medically (PPI); surgery (fundoplication) is for failed/complicated disease. Sliding (type I) hiatal hernia drive