Aim: The incidence of hiatal pathology in our group of patients operated on gastroesophageal reflux disease (GERD) and hiatal hernia (HH) appeared in 98%. We compared the endoscopic and X-ray diagnosis of hiatal patology to peroperative findings. A large number of hiatal pathology of laparoscopically operated patients for GERD and HH lead us to consideration about causal relationship between both above mentioned disorders. Methods: In our group of 2000 laparoscopically operated patients for GERD and HH a comparison of endoscopic and X-ray praeoperative findings to peroperative findings in 100 consecutive patients from 901th to 1000th operated patients in time of our good surgical experience in one department was carried out. Results: A surgeon described 98 hiatal patology during operation, 69 from that was axial hernia, 26 mixed hernia and 3 thoracic stomachs. In last two patients a surgeon was not able to recognise pathology but endoscopist described a hiatal hernia before operation. Endoscopy was done in all operated patients and hiatal pathology was described in 89 patients. On the contrary, in the rest of 11 operated patients a hiatal patology was seen by surgeon. X-ray investigation was performed in 66 operated patients, in 43 of them a hiatal hernia was described. In the rest of the patients a radiologist had not seen hiatal hernia but only during surgery. Conclusions: All laparoscopically operated patients on GERD and HH hernia had proved hiatal pathology. The success of recognising of hiatal pathology in comparison with peroperative findigs was 89% for endoscopy including cardia incompetency and cardia prolaps. Success of X-ray diagnosis for hiatal hernia was only 64% in comparison with peroperative findings. We conclude that negative endoscopy or X-ray does not mean (mostly when important reflux symptoms are present) absence of hiatal hernia. In almost one hundred percent a presence of hiatal pathology of patients operated on GERD has been supported our idea of causal relationship of sliding mechanism, hiatal hernia and GERD. According to our opinion a motility disorder in GERD can be a caused by sliding cardia mechanism which influences firstly anatomy of cardia by lower esophageal sfincter dislocation into mediastinum, negatively influences relationship between diaphragma and esophagus and coincidentally esophageal motility by disturbing of esophageal wall by inflammation as well. If antireflux operation is well done than sliding mechanism, hiatal hernia and cardia’s shape are solved problems. This operation clearly facilitates lower esophageal sfincter pressure and relationship between diaphragma and esophagus. Esophagitis healed by reflux lowering can enable esophageal body a better motility function when this motility disorder is caused by inflammation and then the wall changes are reversible.

        Key words: gastroesophageal reflux disease – hiatal hernia – diagnosis – cause – relationship