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Johns Hopkins Health - Stomach Ache

Winter 2014
Issue No. 23

Stomach Ache

Date: January 1, 2014

Hernias can be painful. Fortunately, the treatment for one type no longer is

Paraesophageal Hernias

Severe chest pain and chronic acid reflux are widely known symptoms that something is wrong, but you might be surprised about the cause for some people. Anne Lidor, M.D., M.P.H., a minimally invasive gastrointestinal surgeon at Johns Hopkins, explains paraesophageal hernias.

How would I know if I have this kind of hernia?
The most frequent symptom of a paraesophageal hernia is acid reflux that doesn’t respond to antacids. Some people get such bad chest pain that they think they’re having a heart attack. Other people might have trouble eating and vomit frequently, and some may vomit blood because the hernia has caused bleeding inside the stomach lining.

Why is it happening?
A paraesophageal hernia develops in your diaphragm, the muscle that helps you breathe by drawing air into the lungs and also divides your chest cavity (heart and lungs) from your abdominal cavity (stomach and intestines). The diaphragm can develop a hole that allows the stomach to migrate up from the abdomen and into the chest.

Should I see a doctor?
Most people are referred to a specialist by their cardiologist or internist, who has already diagnosed the paraesophageal hernia. If your symptoms aren’t affecting your quality of life, the specialist usually won’t do anything. Doctors used to perform surgery right away to prevent the risk of the stomach twisting on itself and causing gangrene. But now we know the risk of that is exceedingly low, especially as you get older.

What if my symptoms become severe?
Then it’s time to talk about surgery. Although some hospitals still perform the repair by making a large incision in the chest, others like Johns Hopkins take a minimally invasive approach. We make five or six small incisions in the abdomen, pull the stomach down and free it from any scar tissue. Then we close the hole in the diaphragm, usually with a biologic mesh; perform an anti-reflux procedure; and tack the stomach to the abdominal wall to keep it from herniating again. This approach is far less painful than open surgery, and it has a much shorter recovery time. There may be minor dietary restrictions, but most people are so happy to be free of symptoms that they don’t mind.

Video Q&A

Watch a Q&A on treatment options for paraesophageal hernias. Visit

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