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Fig. 1A —66-year-old woman with postprandial chest pain and epigastric pain. Upright steep left posterior oblique radiograph from double-contrast upper gastrointestinal examination shows large hiatal hernia. Gastric fundus (large black arrows) has flopped inferiorly beneath most superior portion of gas-filled gastric body (large white arrow). Pooling of barium in floppy fundus is evident, as is small amount of barium spilling into portion of stomach (small black arrows) that traverses diaphragm. Small white arrow denotes location of gastroesophageal junction above diaphragm.