Understanding Paraesophageal Hernia and Its Effects on the Stomach

Written by Medicover Team and Medically Reviewed by Dr Manoj Kumar D , General Surgeons

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

Paraesophageal hernia is a type of hiatal hernia in which a portion of the stomach pushes through the diaphragm alongside the esophagus. Unlike a sliding hiatal hernia, the gastroesophageal junction may remain in its normal position while part of the stomach herniates into the chest cavity.

Paraesophageal hernia can interfere with normal digestion and may cause chest discomfort, difficulty swallowing, acid reflux, or shortness of breath. In severe cases, the herniated stomach can become obstructed or lose its blood supply, making early diagnosis and appropriate treatment important.

What are the Types of Paraesophageal Hernia?

Paraesophageal hernias are classified according to the position of the gastroesophageal junction and the portion of the stomach or other abdominal organs that moves through the diaphragm. The classification helps doctors assess the anatomy and determine appropriate management.

Type I (Sliding Hiatal Hernia): The gastroesophageal junction moves upward through the diaphragmatic hiatus. This is the most common type of hiatal hernia but is not considered a true paraesophageal hernia.
Type II (True Paraesophageal Hernia): The gastroesophageal junction remains in its normal position, while a portion of the stomach herniates into the chest alongside the esophagus.
Type III (Mixed Paraesophageal Hernia): Both the gastroesophageal junction and a portion of the stomach move into the chest cavity. This type combines features of sliding and paraesophageal hernias.
Type IV Paraesophageal Hernia: A large hiatal defect allows the stomach and other abdominal organs, such as the colon or small intestine, to herniate into the chest.

What are the Symptoms of Paraesophageal Hernia?

Paraesophageal hernia symptoms can vary depending on the size of the hernia and whether it affects the stomach or surrounding structures. Some people may have no symptoms, while others develop upper abdominal or chest discomfort and digestive problems.

Chest pain
Difficulty swallowing
Feeling full after eating small amounts
Heartburn
Shortness of breath
Nausea or vomiting

What are the Causes of Paraesophageal Hernia?

Paraesophageal hernias occur when part of the stomach moves through an opening in the diaphragm near the esophagus. The exact cause may vary, but weakness or enlargement of the diaphragmatic opening can allow the stomach to move into the chest.

Age-related changes, increased pressure within the abdomen, and certain anatomical or connective tissue factors may contribute to the development of a paraesophageal hernia.

Increased pressure in the abdomen
Weakness or enlargement of the diaphragmatic opening
Aging-related changes in the diaphragm and surrounding tissues
Congenital or anatomical predisposition
Conditions that place repeated pressure on the abdomen, such as chronic coughing or straining

When to See a Doctor?

Consult a general surgeon if persistent chest or digestive symptoms occur, as early evaluation can help identify a paraesophageal hernia and reduce the risk of complications.

Frequent chest pain or heartburn
Difficulty swallowing
Nausea, vomiting, or shortness of breath
Feeling unusually full after eating small amounts

Get medical help immediately if:

Severe or sudden chest or upper abdominal pain
Persistent vomiting or inability to swallow
Sudden worsening of symptoms or severe abdominal distension
Signs of possible stomach or bowel obstruction

These symptoms may indicate a serious complication such as obstruction or strangulation of the herniated stomach and require urgent medical evaluation.

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How Is Paraesophageal Hernia Diagnosed?

Paraesophageal hernia is diagnosed using a combination of medical history, physical examination, and diagnostic tests. Because symptoms can resemble other digestive or heart-related conditions, imaging and endoscopic evaluation can help confirm the diagnosis and determine the size and anatomy of the hernia.

These tests also help doctors identify complications such as obstruction, inflammation, or changes to the stomach or esophagus.

Barium swallow
Upper endoscopy
Esophageal manometry
pH monitoring when reflux symptoms require further evaluation
Imaging tests such as a CT scan or MRI

What are the Treatment Options for Paraesophageal Hernia?

Treatment for paraesophageal hernia depends on the size of the hernia, symptoms, overall health, and risk of complications. Small or asymptomatic hernias may sometimes be monitored, while symptomatic or complicated hernias may require surgical repair.

Medications and lifestyle changes can help control associated reflux symptoms but do not repair the hernia itself. Surgical treatment may be recommended when symptoms are significant or there is a risk of obstruction or strangulation.

Lifestyle Changes: Eating smaller meals, avoiding foods that trigger reflux, maintaining a healthy weight, and avoiding lying down soon after eating may help manage digestive symptoms.
Medications: Medications such as proton pump inhibitors may reduce stomach acid and relieve heartburn or acid reflux associated with the hernia.
Observation and Monitoring: Selected patients with small or minimally symptomatic hernias may be monitored regularly by their healthcare provider.
Laparoscopic Hernia Repair: Minimally invasive surgery may be used to return the stomach to its normal position and repair the diaphragmatic opening. A Nissen fundoplication may be performed in selected patients, particularly when significant reflux is present.
Open Surgery: Open surgical repair may be required for large or complicated hernias or when minimally invasive surgery is not appropriate.
Emergency Surgery: Urgent surgery may be necessary if the herniated stomach becomes obstructed, twisted, or loses its blood supply.

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What are the Risk Factors of Paraesophageal Hernia?

Several factors can increase the likelihood of developing a paraesophageal hernia. These factors may weaken the diaphragm or increase pressure within the abdomen, allowing the stomach to move through the diaphragmatic opening.