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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.
The most common cause of MWS is severe or prolonged vomiting. While this type of vomiting occurs with illness, it also frequently occurs due to chronic alcohol abuse or bulimia. Although frequent vomiting typically causes MWS, there are other conditions that can result in a tear of the esophagus.