Paraesophageal hernias, also known as hiatal hernias, can cause symptoms such as heartburn, nausea, and regurgitation of food. They are often associated with gastroesophageal reflux disease (GERD). Treatment options include lifestyle changes, medication, and surgery.
The most common symptoms of a paraesophageal hernia, also called a hiatal hernia, are heartburn, nausea, and regurgitation of food after a meal. These symptoms represent a condition called gastroesophageal reflux disease (GERD), which commonly occurs in people with a paraesophageal hernia. It is not known whether a hernia causes GERD, but people with a hiatal hernia may be more prone to GERD symptoms. Some people who have this type of hernia are unaware of the condition because they never show any symptoms.
A hiatal hernia can develop as a sliding hernia or a paraesophageal hernia. In a sliding hernia, which is the most common, part of the stomach bulges into the chest where the stomach and esophagus meet. The protrusion can be permanent or appear only when swallowing. A paraesophageal hernia causes a bulge in the chest near the esophagus that is always present and unaffected by swallowing. Most hernias are the sliding type and rarely cause symptoms.
The condition is diagnosed through an x-ray when a patient suffers from stomach pain. The hernia appears on x-ray film as a pouch between the stomach and esophagus. Patients will be asked to swallow regularly during the exam to determine if a sliding hernia is causing the problem.
Treatment for GERD usually relieves heartburn caused when the sphincter muscle in the lower part of the esophagus malfunctions and allows acid to regurgitate back into the throat. Antacids are effective for some patients, and prescription drugs are available that stop the stomach from producing excess acid. If GERD is left untreated, it can cause an ulcer to develop.
Doctors regularly recommend lifestyle changes to help patients cope with GERD caused by a paraesophageal hernia. Elevating the top of the bed often prevents acid reflux by using gravity to keep the sphincter muscle closed. Eating smaller, more frequent meals and avoiding late night meals might ease symptoms. Greasy, spicy food can contribute to GERD episodes, as can alcohol, caffeine, and chocolate. Some studies have shown that chewing gum helps by producing more saliva which dilutes the acid in the stomach.
If the paraesophageal hernia is large and causing symptoms that don’t respond to medication, surgery is an option. Surgery involves attaching the esophagus to the diaphragm and reducing the size of the sac. Some surgeons choose to repair a hernia even if the patient is showing no symptoms, to avoid the possibility of emergency surgery later. Elective surgery is controversial, however, prompting some doctors to advise waiting until symptoms appear.
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