Hiatal hernia is common and high incidence, and its genesis may be related to elevated intra-abdominal pressure, shortening esophagus and weak diaphragmatic relaxation. On the other hand, hiatal hernia can destroy the anti-reflux mechanism at the lower esophagus, leading to the occurrence of gastroesophageal reflux, while reflux can cause a series of diseases related to the cardiac system, respiratory system and even the otolaryngology. In type Ⅳ hiatal hernia, the entry of a large number of abdominal organs, especially the intestine, can lead to chronic intestinal obstruction, and can even occur incarceration and necrosis, endangering the life of the patient. The all above pathophysiology is the basis for us to understand the occurrence, development and harm of hiatal hernia. It is important for us to further understand and treat esophageal hiatus hernia reasonably. In this paper, we mainly describe the pathophysiology of hiatal hernia.