The swallowing tube (esophagus) passes into the stomach through the esophageal hiatus (the opening in the muscle wall below the lungs (the diaphragm). A hiatal hernia occurs when the upper part of your stomach bulges up through the hiatus into your chest cavity. Most hiatal hernias don't cause problems or require treatment. But a large hiatal hernia can cause food and stomach acid to back up into your esophagus (acid reflux), leading to heartburn and chest pain. The possible causes are: injury to the area, being born with a large hiatus, persistent and intense pressure on the surrounding muscles, such as coughing, vomiting, and straining during the bowel movements or lifting heavy objects.
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