A paraesophageal hernia is a large type of hiatal hernia in which a significant portion of the stomach (more than 30%) pushes up through the diaphragm into the chest cavity. This condition can cause stomach acid to flow upward into your esophagus, leading to heartburn and other symptoms related to gastroesophageal reflux disease (GERD).
UPMC thoracic surgeons have extensive experience performing minimally invasive surgery to treat paraesophageal hernia. Our volumes and success rates with this procedure are among the highest in the nation, as documented by research published in The New England Journal of Medicine.
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What Is Paraesophageal Hernia?
A paraesophageal hernia is a large type of hiatal hernia in which a significant portion of the stomach (more than 30%) pushes up through the diaphragm into the chest cavity. This can cause stomach acid to flow upward into your esophagus, leading to heartburn and other symptoms associated with gastroesophageal reflux disease (GERD), as well as dysphagia (difficulty swallowing), indigestion, or pain in some cases.
How common is paraesophageal hernia?
Hiatal hernia is a common condition, especially as people age. Researchers estimate that hiatal hernias affect about 20% of people in the U.S., including 55% to 60% percent of people over age 50. However, paraesophageal hernias are less common.
What causes paraesophageal hernia?
Although the exact cause of paraesophageal hernia is unclear, doctors believe the condition is linked to weakness in the diaphragm and supporting tissue, leading to herniation of the stomach into the chest cavity.
Paraesophageal hernia risk factors
Older age is the primary risk factor for paraesophageal hernia, with more than half of people over age 50 having a hiatal hernia. Obesity and smoking may also increase your risk of developing paraesophageal hernia.
Complications of paraesophageal hernia
Complications of paraesophageal hernia may include:
- Aspiration — Inhaling food particles or saliva into your lungs.
- Internal bleeding — Which could lead to anemia (low red blood cell count).
- Strangulation — Which happens in rare cases when the hernia becomes trapped by the surrounding tissues.
How can I prevent paraesophageal hernia?
You may not be able to control all your risk factors for paraesophageal hernia. However, maintaining a healthy weight and quitting smoking may help reduce your risk.
What Are the Signs and Symptoms of Paraesophageal Hernia?
In many cases, hiatal hernias may not cause symptoms — particularly if they are small and slide into and out of place at times.
However, paraesophageal hernia may cause significant symptoms, including:
- Acid reflux.
- Chest pain.
- Heartburn.
- Difficulty swallowing.
When should I see a doctor about my paraesophageal hernia symptoms?
If you have paraesophageal hernia symptoms or other symptoms of GERD, you should schedule an appointment with your doctor. Early treatment can reduce your risk of complications and improve your quality of life.
How Do You Diagnose Paraesophageal Hernia?
Your doctor may suspect a paraesophageal hernia if you have frequent or long-term heartburn.
What to expect during your visit
If your doctor suspects paraesophageal hernia, they will:
- Ask about your symptoms.
- Perform a physical exam.
- Order other tests.
- Review your health history and medications.
Tests to diagnose paraesophageal hernia
Your doctor may order tests and evaluations to diagnose paraesophageal hernia, including:
- Esophageal imaging (barium swallow study) — You will swallow a chalky liquid to help your esophagus appear more clearly on x-ray images.
- Esophageal manometry — Studies the pressure inside your esophagus.
- Esophageal pH test — Your doctor will insert a thin tube through your nose and down your throat to measure acid levels in your esophagus. In some cases, your doctor may insert an attachable esophageal capsule during an endoscopy to measure acid levels. This study may be performed over a 24- or 48-hour period to monitor acid levels over time.
- Upper endoscopy — Your doctor will use a lighted tube with a camera called an endoscope to look inside your esophagus and stomach.
Paraesophageal hernia prognosis
Surgery is a highly effective treatment that can repair a paraesophageal hernia and improve symptoms.
How Do You Treat Paraesophageal Hernia?
The goal of paraesophageal hernia treatment is to repair the hernia and reduce or eliminate symptoms. Treatment options may include:
Lifestyle changes for paraesophageal hernia symptoms
Your doctor may recommend lifestyle changes to reduce symptoms, including:
- Avoiding lying down or bending over after eating.
- Eating smaller portions and avoiding large, heavy meals.
- Maintaining a healthy weight.
- Quitting smoking.
- Raising the head of your bed to avoid lying flat at night.
Medications for paraesophageal hernia symptoms
Your doctor may recommend or prescribe medications to control stomach acid, including:
- Antacids — Medicines with calcium carbonate can relieve mild symptoms of GERD. Brand names include TUMS, Rolaids®, and Alka-Seltzer®. You shouldn't use them for severe symptoms, as they can cause diarrhea or constipation.
- H2 blockers — These drugs lower the amount of acid your stomach makes. You can buy the drug at the drugstore under the brand names PEPCID® (famotidine). Or your doctor can prescribe drugs with cimetidine or nizatidine.
- Proton pump inhibitors (PPIs) —These drugs also lower the amount of acid your stomach makes and can help heal your esophageal lining. There are many active PPIs your doctor can prescribe. You can also buy them at the drug store under the brand names Prilosec OTC®, Nexium®, and Prevacid®.
Surgery to treat paraesophageal hernia
Although lifestyle changes and medications may help control symptoms, they will not treat the paraesophageal hernia itself. Many paraesophageal hernias require surgery.
Laparoscopic surgery for paraesophageal hernia
At UPMC, we treat paraesophageal hernia using a minimally invasive surgical technique. Your surgical team will recommend the best type of repair surgery for you.
What size paraesophageal hernia needs surgery?
Your doctor may recommend surgery if more than 30% of your stomach pushes up through your diaphragm, or if your paraesophageal hernia is causing symptoms that affect your quality of life.
Why Choose UPMC for Paraesophageal Hernia Care?
When you choose UPMC for paraesophageal hernia care, you will receive:
- Access to board-certified specialists — Our gastrointestinal specialists are experienced in caring for people with paraesophageal hernia and related complications.
- Expert diagnosis and personalized care — Our team will develop a customized treatment plan to reduce your risk of complications and improve your quality of life.
- A full range of treatment options — We use the latest nonsurgical and minimally invasive surgical techniques to provide comprehensive paraesophageal hernia care.
