The association of esophageal hiatal hernias with gastro-esophageal reflux disease was recognized long ago, however its origins are still disputed. The anatomy of the diaphragm and esophagogastric junction appears to be crucial to hiatal hernia development. The aim of this paper was to perform a literature review to present the current state of knowledge regarding the anatomy and pathology of esophageal sliding hiatal hernias. An electronic journal search was undertaken to identify all relevant studies published in English regarding esophageal hiatal hernias. This search included the Medline and Embase databases from 1962 to 2013. The following keywords were used in various combinations: hiatus hernia, hiatal, gastro-esophageal reflux disease, etiology, anatomy, and esophageal. The nature of a hiatal hernia is complicated by the multifactorial etiology of the disease, which involves the interplay of genetic and environmental factors. Its anatomy is still a matter of dispute. The exact point at which hernia development begins has yet to be understood.
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