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[3] described three dominant hypotheses of HH, which are as follows: (1) increased intra-abdominal pressure that moves the gastroesophageal junction into the thorax cavity, (2) esophageal shortening from innate causes or acquired caused by fibrosis, and (3) widening of the orifice from innate or acquired changes in the crural muscles or connective tissue of the diaphragm

These toxins come from many sources such as air pollution