For a study, the researchers sought to investigate the development and natural history of a hiatal hernia using a barium upper gastrointestinal series (UGI). Although Hiatal hernias were widespread, little was known about the natural history of sliding and paraesophageal hernias. Investigators used a word scanning software application to look through UGI reports from 1987 to 2017 to find people who had a hiatal hernia. Only those with at least 2 UGI trials separated by 5 years were chosen. Following that, the studies were examined. About 89 people matched the requirements for inclusion. On initial UGI, 21 persons had no hiatal hernia, but 16 acquired a sliding hiatal hernia (SHH), and 5 developed a PEH over 99 months. An SHH was found on initial UGI in 55 persons, and after a median of 84 months, UGI revealed that the SHH had remained stable in 11 (20%), grown in size in 30 (55%), and transformed to a PEH in 14 people (25% ). A PEH was found on the first UGI in 13 people, and it remained steady in 5 people and grew in size in 8 people during a median of 97 months (62%). In a follow-up UGI study, the study group discovered that both SHH and PEH can develop over time and that the majority of both grew in size. Furthermore, 25% of SHH developed into PEH over time. Recognizing a change in the size or kind of a hiatal hernia may be therapeutically helpful in understanding a person’s changing or worsening symptoms.