According to Dr . Denis Burkitt, " Hiatus hernia has its maximum prevalence in economically developed communities in North America and Western Europe . . . In contrast the disease is rare in situations typified by rural African communities . " Burkitt attributes the disease to insufficient dietary fiber and the use of the unnatural sitting position for defecation.
12.
A hiatus hernia is a particular variant of this type, in which the normal passageway through which the esophagus meets the stomach ( gastroesophageal junction itself slides through the defect into the chest, or non-sliding ( also known as " para-esophageal " ), in which case the junction remains fixed while another portion of the stomach moves up through the defect.
13.
Of these, 9 % are symptomatic, depending on the competence of the lower esophageal sphincter ( LES ) . 95 % of these are " sliding " hiatus hernias, in which the LES protrudes above the diaphragm along with the stomach, and only 5 % are the " rolling " type ( paraesophageal ), in which the LES remains stationary but the stomach protrudes above the diaphragm.
