A hernia occurs when an internal body part pushes through a weakness in the muscle or surrounding tissue. While most hernias appear in the abdomen or groin, they can also develop in the chest.
What is a Chest Hernia?
A chest hernia, most frequently a hiatal hernia, involves an internal organ, typically a portion of the stomach, pushing up through an opening in the diaphragm. The esophagus passes through a natural opening in the diaphragm called the hiatus.
In a hiatal hernia, this hiatus widens, allowing the upper part of the stomach to bulge into the chest. The most common form is a sliding hiatal hernia, where the stomach and lower esophagus intermittently slide into and out of the chest. Less common types, known as paraesophageal hernias, occur when a part of the stomach pushes up alongside the esophagus and remains in the chest.
Increased pressure within the abdominal cavity can contribute to a chest hernia. This pressure may arise from chronic coughing, straining during bowel movements, or frequently lifting heavy objects. Age-related changes can also weaken the diaphragm, and some individuals may be born with a naturally larger hiatal opening.
Recognizing the Signs
Many individuals with a chest hernia, particularly a small hiatal hernia, may not experience noticeable symptoms. When symptoms do occur, they are often related to acid reflux.
Common indicators include heartburn and the backward flow of stomach acid or undigested food into the mouth. Some individuals may experience chest pain, which can be confused with heart-related issues. Difficulty swallowing, a feeling of fullness after eating, belching, and bloating are also reported. Shortness of breath can occur if the hernia is large enough to put pressure on the lungs.
How Chest Hernias are Identified
A common initial test is a barium swallow, also known as an esophagram or upper gastrointestinal X-ray. During this procedure, the individual drinks a liquid containing barium, making the esophagus and stomach visible on X-ray images.
Another method is an upper GI endoscopy. This involves inserting a flexible tube with a camera, called an endoscope, down the throat into the esophagus and stomach to visualize the structures and identify the hernia.
Further tests may include pH monitoring, which measures stomach acid flow into the esophagus. Esophageal manometry may also assess the strength of muscle contractions in the esophagus.
Options for Care and Prevention
Managing chest hernias often begins with non-surgical approaches to alleviate symptoms, especially those related to acid reflux. Eating smaller, more frequent meals and avoiding trigger foods like fatty items, acidic foods, caffeine, and alcohol can help. Elevating the head of the bed and avoiding lying down immediately after meals can also prevent acid reflux.
Medications can also help manage symptoms by reducing stomach acid. These include antacids for quick relief, H2-receptor blockers that decrease acid production, and proton pump inhibitors (PPIs) that block acid production and allow the esophagus to heal. These medications do not repair the hernia itself but address its symptomatic effects.
Surgical repair is considered when symptoms are severe and do not respond to medication and lifestyle changes, or if complications like severe inflammation, esophageal narrowing, or strangulation occur. Surgery aims to pull the stomach back into the abdominal cavity and tighten the diaphragm opening. Procedures often involve minimally invasive laparoscopic techniques using small incisions. Preventive measures include maintaining a healthy weight, avoiding straining during bowel movements, and lifting heavy objects properly.