Overview Introduction Present in 80% of patients with reflux. Type I: Sliding hiatal hernia most common type GE junction and stomach slide into mediastinum through diaphragmatic esophageal hiatus loss of diaphragm reinforcement allows reflux of stomach acid Type II: Paraesophageal hiatal hernia herniation of stomach fundus through diaphragm parallel to esophagus GE junction remains at level of the esophageal hiatus Presentation Similar to GERD Physical exam bowel sounds ausculated over left lower lung Treatment Type I medical therapy similar to GERD Type II mandatory surgical repair due to risk of strangulation