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The most common symptoms of paraesophageal hernia, also called a hiatal hernia, are heartburn, nausea, and regurgitation of food after a meal. These symptoms represent a condition called gastroesphageal reflux disease (GERD), which commonly occurs in people with a paraesophageal hernia. It is not known if the 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 exhibit any symptoms.
A hiatal hernia can develop as a sliding hernia or paraesophageal hernia. In a sliding hernia, which is most common, part of the stomach bulges into the chest where the stomach and the esophagus meet. The protrusion may be permanent or only appear when swallowing. A paraesophageal hernia causes a bulge into the chest next to the esophagus that is always present and is not affected by swallowing. Most hernias are the sliding type and rarely cause symptoms.
The condition is diagnosed through an x-ray when a patient suffers gastric pain. The hernia appears on the x-ray film as a sac between the stomach and esophagus. Patients will routinely be asked to swallow during the examination to determine if a sliding hernia is causing the problem.
Treatment for GERD usually relieves heartburn caused when the sphincter muscle at the lower part of the esophagus malfunctions and allows acid to regurgitate into the throat. Antacids are effective for some patients, and prescription drugs are available that block the production of excess acid in the stomach. If GERD is left untreated, it may cause an ulcer to develop.
Doctors routinely recommend lifestyle changes to help patients cope with GERD caused by a paraesophageal hernia. Elevating the upper part of the bed often prevents acid reflux by using gravity to keep the sphincter muscle closed. Eating smaller and more frequent meals, and avoiding late-night meals, might relieve symptoms. Fatty and spicy food can contribute to episodes of GERD, as well as alcohol, caffeine, and chocolate. Some studies have shown that chewing gum helps by producing more saliva that 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 opt to repair a hernia even if the patient shows 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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