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Digestive Disorders

Hiatal Hernia Issue

03/11/2010

Question:

A few years back, my husband had upper abdominal pain (note: no heartburn or acid reflux issues), had endoscope and was diagnosed with a hiatal hernia and took aciphex for about two years which seemed to help quite a bit so he stopped and did not have anymore trouble until now. Husband has had shortness of breath and upper abdominal pain for the past several months now and had various heart/lung tests which all came back normal except when a second opinion for another endoscope procedure revealed a medium hiatal hernia but the doc says this should not be causing the pain but doc prescribed prilosec but this not helping. Husband`s recent line of work is heavy lifting, pulling, pushing, etc. and with new job started back the upper abdominal pain and shortness of breath when doing these things. He is off work now due to this situation. Sometimes the pain is better. If do streneous activity, the pain increases or if he breathes in deep or sneezes hard, it increases the pain --- yet other tests and x-rays, CT Scan of abdomin and chest, etc. show nothing else going on. The question is could it be the hernia causing the pain and shortness of breath and if diagnosed with a hernia and causing this bad of symptoms why would doc say that hernia not causing this pain and shortness of breath? I have read many articles and get confused as some say hernia can get stuck or strangulated or other issues. Doc did not say what kind of hernia if it was sliding or fixed or what. Please help in understanding hiatal hernia or give helpful advice as to what to do or should we get a third opinion. Thanks.

Answer:

There are different types of hiatal hernias. In most, just the upper part of the stomach is pushed through the opening in the diaphragm (the muscle sheet separating the chest from the abdomen). In some cases major amounts of the stomach can be pushed into the chest. The stomach may go in and out through this "hiatus" in the diaphragm (hence the term hiatal hernia) and if most of it at some point is in the chest it may cause these symptoms. It may be intermittent and usually a barium upper GI x-ray is the most helpful test. The question of the type of hernia (sliding, paraesophageal) should be addressed with your doctor.

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Response by:

D Roy Ferguson, MD D Roy Ferguson, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University