Paraesophageal Hiatal Hernia Review

Paraesophageal Hiatal Hernia

For most people, a hiatal hernia refers to a condition in which a piece of the stomach as well as its connection to the esophagus are pushed upwards through the diaphragm through an opening called the hiatus. This results in a little bulge situated atop the chest cavity separator. However, in the case of a more serious paraesophageal hiatal hernia, the stomach gets pushed up through that same opening, but rests alongside the esophagus, creating a thinner and longer bulge. This distinction not only helps explain what is a hiatal hernia, but also emphasizes the important difference between these two common types.

Of the four different hiatal hernia types, sliding is the most common and often requires no treatment at all, although acid reducing medications and dietary changes are often employed. However, a paraesophageal hiatal hernia can be much more serious, and when the condition is combined in higher stage hiatal hernias, there can be greater complication risk. For instance, a stage III condition involves the combination of a sliding and paraesophageal hiatal hernia, and two bulges exist alongside each other atop the chest cavity barrier. The greatest risk that comes from this situation is a strangulated hiatal hernia in which the blood supply to the stomach is cut off. Surgical repair is required in this case.

Most of the time however, hiatal hernia medications are used if symptoms are present. These medications are used to reduce the amount of stomach acid that is present. Because of the unnatural position of the stomach in relation to the esophagus, the symptoms of GERD can be exacerbated. Proton pump inhibitors and H2 receptor blockers are medications that are commonly used in persons with a paraesophageal hiatal hernia, and these can help bring about some symptom relief. However, in addition to medications, other lifestyle treatments like lying down if symptoms present or sipping room temperature water may also bring some relief.

Unfortunately, medications are not always enough to treat a paraesophageal hiatal hernia, and in some cases the condition can worsen or the hernia can become larger. In these situations a surgical repair is often the best method of treatment. Surgery can become advisable if certain hiatal hernia pain symptoms become present. These symptoms often include pain in the chest and pain in the upper part of the abdomen. Some individuals may also encounter difficulty breathing and swallowing as well as ulcers that contribute to hiatal hernia pain. When these uncomfortable symptoms become chronic, a laparoscopy procedure may follow. Unless the hernia is large, the procedure is usually simple and involves moving the stomach back where it belongs, closing the hiatus and wrapping to keep the stomach from making its way back through the opening again.

A paraesophageal hiatal hernia can be either an asymptomatic nuisance or a serious medical condition. Proper evaluation from a medical provider including an x-ray for thorough diagnosis is important to determining the severity of the condition. Even people who have this type of hernia that have no symptoms early on may find that over time their symptoms can become more severe. It’s important that people with this less common and more serious type of hiatal hernia remain under the care of a medical professional for thorough symptom monitoring as complications can be serious and even life threatening if left untreated. Most of the time, with adequate lifestyle changes including sensible modifications to diet and activity level, first and second stage hernias are easily managed.

References:
http://patient.info/health/hiatus-hernia-leaflet
http://www.mcw.edu/General-Surgery/Patient-Info/GERD-Surgery-Program/Paraesophageal-Hernia.htm