Paraesophageal Hernia

A hernia develops when an organ or fatty tissue squeezes through a weak spot in the surrounding muscle or connective tissue (fascia). A large, dome-shaped muscle below the lungs, the diaphragm is a fascia that separates the chest and abdomen. To carry food to the stomach, the esophagus passes through a small opening in the diaphragm (hiatus) before it connects to the stomach at the gastroesophageal junction. A hiatal hernia occurs when part of the stomach pushes up into the chest through the hiatus.

Types of Hiatal Hernias

There are two main types of hiatal hernias:

• Sliding hiatal hernias – Part of the stomach and the gastroesophageal junction slide into the chest.
• Paraesophageal hiatal hernias – The upper part of the stomach herniates through the hiatus and lies alongside the esophagus, but the gastroesophageal junction remains in place.

Paraesophageal hiatal hernias are less common but more severe than sliding hiatal hernias. Though rare, possible complications include:

• Severe gastroesophageal reflux disease (GERD) – Stomach acid and contents flow backward into the esophagus, causing irritation and inflammation.
• Barrett’s esophagus – The cells in the esophageal lining undergo abnormal changes, increasing the risk of esophageal cancer.
• Incarceration – The herniated stomach becomes entrapped in the chest cavity and cannot easily be returned to its normal position.
• Strangulation – The blood supply to the herniated stomach is cut off, leading to tissue damage.

Paraesophageal Hernia Causes and Risk Factors

Most hiatal hernias result from an enlarged or weakened hiatus. In some cases, the opening in the diaphragm is larger than normal at birth. The hiatus can also become weakened due to:

• Age-related changes in the diaphragm
• Trauma to the chest or upper abdomen
• Increased pressure in the abdomen caused by obesity, pregnancy or straining during bowel movements

The risk factors for hiatal hernias include:

• Advanced age
• Excess body weight and obesity
• Smoking and other forms of tobacco use
• A history of hiatal hernias
• Chronic coughing
• Prior surgery or injury to the chest or upper abdomen

Paraesophageal Hernia Symptoms

The symptoms of a paraesophageal hernia can include:

• Chest pain
• Difficulty swallowing (dysphagia)
• Feeling full quickly when eating
• Regurgitation of food
• Heartburn
• Nausea and vomiting
• Abdominal bloating

Paraesophageal Hernia Diagnosis

The diagnostic process for a paraesophageal hernia typically begins with a physical examination and medical history review. From there, the physician may order testing, such as:

• Upper gastrointestinal (GI) series (barium swallow) – Before X-rays are taken, the patient will drink a liquid containing a silver-white metallic compound (barium), which will coat the esophagus and stomach and highlight any abnormalities in the resulting images.
• Upper endoscopy – A physician will guide a long, flexible tube with a miniature camera attached to the end (endoscope) down the throat, then use the camera to visualize the esophagus and stomach and check for inflammation and other signs of a hernia.
• Esophageal pH monitoring – Using a thin tube passed through the nose or a wireless pH probe, a physician will determine how much stomach acid is entering the esophagus and how long it remains there.

Paraesophageal Hernia Treatment

Treatment for a paraesophageal hernia can vary based on the size and severity of the hernia and whether it is causing symptoms. In some cases, treatment is unnecessary, especially if the hernia is small and does not cause discomfort. However, if the hernia is large or causing disruptive symptoms, a physician may suggest making positive lifestyle changes, such as:

• Weight loss (if necessary) to relieve pressure in the abdomen
• Dietary changes, such as avoiding caffeine, alcoholic beverages and certain foods that cause or worsen the symptoms
• Sleeping with the head and upper body elevated to help reduce acid reflux
• Medications, such as antacids or proton pump inhibitors, to reduce stomach acid and relieve symptoms

To address severe or persistent symptoms, paraesophageal hernia repair surgery may be considered.

Benefit From World-Class Care at TGH

The TGH Digestive Diseases Institute is a world-class center of excellence for gastroenterology and GI surgery. Our multidisciplinary team specializes in the prevention, diagnosis and treatment of a full range of conditions that impact the gastrointestinal tract, including paraesophageal hernias.

If you would like to learn more, contact TGH at (800) 822-3627 to request an appointment with a specialist in Tampa, FL.