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Background-Familial hiatal hernia has only rarely been documented. Aims-To describe the pattern of inheritance of familial hiatal hernia within an aVected family. Subjects-Thirty eight members of a family pedigree across five generations. Methods-All family members were interviewed and investigated by barium meal for evidence of a hiatal hernia. Results-Twenty three of 38 family members had radiological evidence of a hiatal hernia. No individual with a hiatal hernia was born to unaVected parents. In one case direct male to male transmission was shown. Conclusions-Familial inheritance of hiatal hernia does occur. Evidence of direct male to male transmission points to an autosomal dominant mode of inheritance. (Gut 1999;45:649-652)

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