Introduction The diagnosis and clinical significance of hiatal hernia has been the subject of numerous reports. No symptom pattern is diagnostic, and various diseases, which are often associated, may cause similar complaints. Moreover, severe complications such as bleeding and stenosis sometimes occur without an antecedent history. The use of specialized radiologic techniques and the redefining of the radiologic criteria are responsible for the apparently increased incidence of sliding hiatal hernia in recent years.1-3 Inflammation of the esophageal wall may be present before macroscopic lesions are evident. Intraluminal pH measurements have demonstrated a high incidence of gastroesophageal regurgitation.4,5 Esophageal symptoms have been reproduced by infusion of 0.1 N HCl.5 Motor dysfunction of the esophagus has been demonstrated in patients with hiatal hernia.6-12 This report is based upon study of several hundred patients with hiatal hernia using a combination of approaches, including assessment of the clinical features, routine