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A diaphragmatic hernia that occurs through this opening is called a hiatus hernia. The cause of hiatus hernia is usually unknown, but it may be caused by stretching of the bands of tissue that are attached between the esophagus and diaphragm at the hiatus. The condition is more common among people who are older than 50, who are overweight (particularly women), or who smoke.
Barrett's esophagus occurs due to chronic inflammation. The principal cause of the chronic inflammation is gastroesophageal reflux disease, GERD (UK: GORD). In this disease, acidic stomach, bile, and small intestine and pancreatic contents cause damage to the cells of the lower esophagus.