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It is associated with decreased oesophageal peristalsis, increases the cross\u2010sectional area of the oesophago\u2010gastric junction, and acts as a reservoir allowing reflux from the hernia sac into the oesophagus during swallowing. The overall effect is that of increased oesophageal acid exposure. The presence of a hiatus hernia is associated with symptoms of gastro\u2010oesophageal reflux, increased prevalence and severity of reflux oesophagitis, as well as Barrett's oesophagus and oesophageal adenocarcinoma. The efficacy of treatment with proton pump inhibitors is reduced. Our view on the significance of the sliding hiatus hernia in gastro\u2010oesophageal reflux disease has changed enormously in recent decades. It was initially thought that a hiatus hernia had to be present for reflux oesophagitis to occur. Subsequently, the hiatus hernia was considered an incidental finding of little consequence. We now appreciate that the hiatus hernia has major patho\u2010physiological effects favouring gastro\u2010oesophageal reflux and hence contributing to oesophageal mucosal injury, particularly in patients with severe gastro\u2010oesophageal reflux disease.<\/jats:p>","DOI":"10.1111\/j.1365-2036.2004.02149.x","type":"journal-article","created":{"date-parts":[[2004,9,21]],"date-time":"2004-09-21T08:18:36Z","timestamp":1095754716000},"page":"719-732","source":"Crossref","is-referenced-by-count":148,"title":["The role of the hiatus hernia in gastro\u2010oesophageal reflux disease"],"prefix":"10.1111","volume":"20","author":[{"given":"C.","family":"Gordon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Y.","family":"Kang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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