A 71-year-old obese female with a 20-year history of GERD on chronic omeprazole 40 mg daily presents with worsening postprandial dysphagia, regurgitation of undigested food when supine, chronic cough, and early satiety with 6 kg weight loss. Upper GI endoscopy and CT imaging confirm a Type III mixed paraesophageal hiatal hernia. The structure marked **A** in the diagram—the migrated gastroesophageal junction (GEJ) above the diaphragmatic level in the mediastinum—is the defining anatomical feature of the sliding component of this hernia. Which of the following best describes the PRIMARY PATHOPHYSIOLOGICAL MECHANISM that has resulted in upward migration of the structure marked **A** in this patient?
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