The term of hiatal hernia means a transposition of oral part of stomach and distal part of esophagus (what are the parts placed under the diaphragma in a normal conditions) through an esophageal hiatus into the thorax cavity. The endoscopy definition of hiatal hernia is a circular pull-up of the stomach more than 2 cm above the diaphragma to Z-line when measured during endoscope extraction. Hiatal hernia is mostly an acquired state. It is caused by insufficient fixation of a cardioesophageal area when abdominal part of esophagus and stomach rise above diaphragma hiatus. Provoking factors are mentioned mostly as an increase of intraabdominal pressure. Classification of hiatal hernia types is as follows: 1. axial type (sliding, type I) – when esophagus and part of stomach including gastroesophageal junction are placed above diaphragma, 2. paraesophageal (type II) – esophagus and gastroesophageal junction are placed under the diaphragma and part of the stomach in a revert position (so called up and down stomach) is placed in the thorax cavity, 3 mixed (type III) is a combination of both, sliding and paraesophageal hernia. Endoscopy and radiology studies showed 50–94 % of patients suffering from esophageal reflux disease had hiatal hernia type I. But most patients with hiatal hernia have no esophageal reflux disease. Hiatal hernia is a factor worsening esophagitis when refluxated material is kept in its bag and successively prologs the time of clearing. Hiatal hernia may be manifested by complications as esophagitis and peptic ulcer and followed by bleeding. A great hiatal hernia may strangulate, to be a cause of anemia or bleeding, cause of chest pain and dyspnea after meals. Hiatal hernia itself has no symptoms and treatment is not indicated. The treatment is useful when the hernia makes a pressure on surrounding structures or complicated by mucosal changes. Management is conservative by antisecretory compounds or surgery. Isolated asymptomatic hiatal hernia type I is not useful for surgery. Esophageal reflux disease is a multifactorial process and a hiatal hernia is a supportive factor for its start and preservation of this status.

        Key words: hiatal hernia – esophageal reflux disease