Figure 6 - Alteration of the hiatal anatomy associated with sliding hiatal hernia.

Note that the main change is a widening of the hiatal canal. Associated with this, there can be substantial atrophy of the abutting muscular elements, thinning and elongation of the phrenoesophageal membrane, and axial displacement of the gastric cardia. (Source: Modified from Marchand⁵ with permission from Society of Thoracic Surgeons.)