Paraesophageal Hernias

When an internal body part pushes into another area of the body, it is called a hernia. When the stomach moves up through the diaphragm – as in a hiatal hernia – and distorts the esophagus, it is called a paraesophageal hernia. Paraesophageal hernias will increase in size over time, and may involve the entire stomach and other organs, like the colon or small bowel, bulging into the chest cavity. If they become twisted, the blood supply to the stomach can be interrupted, necessitating immediate treatment.

Symptoms of Paraesophageal Hernias

Signs and symptoms of a paraesophageal hernia can include:

  • Anemia – iron deficiency
  • Acid reflux – backflow of stomach acid into the esophagus
  • Chest pain, often when eating large meals, centrally located and unresponsive to antacids
  • Dysphagia – difficulty eating or swallowing or food feeling stuck in the chest
  • Early satiety – feeling full quicker with meals
  • No response to gastroesophageal reflux disease (GERD) medication
  • Persistent heartburn
  • Regurgitation of food or liquids into the mouth
  • Shortness of breath
  • Upper abdominal pain
  • Vomiting of blood or passing of black stools

Diagnosing Paraesophageal Hernias

Based on your medical history and your signs and symptoms, your doctor may suspect a hernia and refer you to a gastroenterologist. Tests and procedures used to diagnose a paraesophageal hernia include:

  • Chest X-ray
     
  • X-ray of your upper digestive system: You may be asked to drink a liquid that coats the inside of your digestive tract to allow your doctor to see a silhouette of your esophagus, stomach and upper intestine.
     
  • Upper endoscopy: A small tube with a camera is inserted through your mouth and throat to examine the inside of your esophagus and stomach to check for inflammation.
     
  • Esophageal manometry: This test measures the rhythmic muscle contractions, coordination and force in your esophagus when you swallow.

Treating Paraesophageal Hernias

Paraesophageal hernias may be initially treated with medication or lifestyle changes. If it is confirmed that you have a paraesophageal hernia, you should be assessed by a surgeon.

Dietary and Lifestyle Changes
Your doctor will review your symptoms with you and may recommend that you:

  • Avoid certain foods and drinks that trigger heartburn, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion and caffeine
  • Always eat small meals, eating several hours before sleeping and avoiding lying down after a meal
  • Elevate the head of your bed or use a wedge pillow
  • Stop smoking
  • Lose weight

Surgery
When medications do not relieve heartburn and acid reflux, or if complications such as severe inflammation or narrowing of the esophagus arise, surgery may be required. Virginia Mason’s esophageal surgery team members are experts in repairing paraesophageal hernias, and will use the most current evidence to guide you in understanding which surgical approach is best for you, including the possibility of minimally invasive surgery. The aims of surgery may include pulling your stomach back down into your abdomen, decreasing the size of the opening in your diaphragm, reconstructing an esophageal sphincter or removing the hernia sac.

To schedule an appointment with Virginia Mason's thoracic surgeons call (206) 341-1905.