• Opening in diaphragm becomes enlarged, part of upper stomach moves up into lower portion of thorax
• Sliding hiatal hernia (Type 1)-upperstomach & gastroesophageal junction displaced upward & slide in and out of thorax
• Paraesophageal hernia- all/part of stomach pushes through diaphragm beside esophagus

Manifestations:

• Sliding hiatal- REFLUX, heartburn, dysphagia,asymptomatic
• Parasesophageal hernia- fullness, chest pain after eating

Management:

• Small feedings
• DO NOT recline 1hr after eating
• Elev. head of bed