In the rolling type, the junction remains in the abdomen, but the fundus and upper body of the stomach migrate upward. Rolling hiatal hernia is much less common and is not typically associated with dyspeptic symptoms. Sliding hiatal hernia is frequently associated with gastroesophageal reflux disease and is characterized by heartburn, regurgitation, belching, bloating, cough and asthma. In severe cases, dysphagia and painful swallowing may occur. Endoscopy has largely replaced barium studies in the diagnosis and assessment of hiatal hernia.
Treatment is indicated if symptoms become problematic.
Weight reduction, diet modification, raising the head of the bed and reduction of alcohol, caffeine and nicotine intake are all recommended. A number of antireflux therapies are available, ranging from simple antacids to histamine H 2 -receptor antagonists and proton pump inhibitors, and therapy should be individualized to control symptoms. Surgery should be considered in severe and resistant cases of hiatal hernia. Several laparoscopic and open procedures are available, each with specific indications and complications. As the tone of the upper airway musculature decreases during sleep, narrowing of the airway can result in snoring.