What are the signs and symptoms of a paraesophageal hernia?
- Many hiatal hernias are asymptomatic and are first recognized on chest radiography. Type I is often associated with reflux but does not cause direct symptoms.
- Paraesophageal hernias classically cause symptoms of substernal chest pain, often thought to be cardiac in origin, and shortness of breath after eating. Shortness of breath is secondary to loss of vital capacity caused by impingement of hernia contents on the lung.
- Other symptoms, which may or may not be present, include dysphagia, early satiety, abdominal bloating, and GE reflux, as well as aspiration manifested by chronic cough, dyspnea, and wheezing.
- Cameron ulcers are often the cause of unexplained microcytic anemia in older adults with otherwise normal upper and lower endoscopy.
- Rarely, acute herniation occurs, causing sudden pain and symptoms of gastric outlet obstruction. Strangulation can cause gastric necrosis, resulting in rapid decompensation, shock, and death.
