Which hiatal hernia is defined by the gastroesophageal junction moving above the diaphragm into the mediastinum?

• A. Type II paraesophageal
• B. Type I sliding
• C. Type III mixed
• D. Type IV large hiatal hernia

Answer: (B)

In hiatal hernias, the key distinction is where the gastroesophageal junction sits relative to the diaphragm. The sliding type is defined by the gastroesophageal junction migrating up into the thorax, moving above the diaphragm into the mediastinum (often with part of the stomach). This makes the GEJ the abnormal, intrathoracic landmark and is why this form is described as sliding. Other types differ: paraesophageal keeps the GEJ below the diaphragm while part of the stomach herniates beside the esophagus; mixed type involves both the GEJ and stomach above the diaphragm; and the large type can involve other abdominal organs herniating into the chest.