Para esophageal hernia ( stomach in thoracic chest)

Hi Lizziel1, Thank you for your reply. My concern is that there is no long term clinical studies on PPIs. I am concerned about its effects on kidney function. I am not in favor of surgery for a wide variety of reasons- I would need to have an open procedure and not laparoscopic because of adhesions from another surgery. For now I am managing pretty well with careful dietary changes and watching how much and when I eat. I have recently gotten off the PPI and am on Famotidine 20-40mg and seem to be doing OK. I typically end up in the ED once every 1.5-2 yrs with excruciating pain. I have a history of Cameron ulcers from when my stomach was sliding up and down through my diaphragm. I also have read that a person can still have a micro mist of gastric acid that comes up the esophagus despite taking the medication. I fear developing Barretts's cancerous esophagus. Surgery itself is not always successful over the long term. I know some people develop vagal nerve issues or ongoing wrap too tight issues. For now, I am going to try to medically manage and avoid surgery. Another concern I have is that proton pump inhibitors such as Omeprazole tend to make Rosacea (facial immune disorder) flair up. One other concern is also that the medications disrupt the microbiome of our gastro-intestinal system and then our ability to absorb nutrients is negatively affected. Thank you again for you response. I hope we both can continue to medically manage our conditions and not have surgery!

I too have a hiatal hernia and my stomach is also pushing up in my chest I need surgery but I have heard so many bad things about having a hiatal hernia repair I'm now scared to do it I also deal with chronic constipation that doesn't help much either I have tried to make some life style changes that has helped some but I still have to take PPIs all the time and sometimes that doesn't even help I'm unsure of what to do anymore 😔

I had the same thing along with intersussession
Intestines were folding inside (like a telescope) along with migrating into chest. Surgeon fixed it no problems

Like you I am living with it, but at 75 and still in good health am wondering how wise it is to keep postponing surgery. I have been on PPIs for over 20 years and can't remember ever having heartburn or feeling any reflux. I do get short of breath when doing anything strenuous beyond a brisk walk and I have had a few episodes of dysphagia while eating out at restaurants. These episodes don't last very long and typically I can avoid future episodes by eating small portions especially when eating rich foods. I haven't had any episodes for over a year and a half. In 2022 an EGD and barium swallow indicated I had a large hiatal hernia with approximately 70% of the stomach herniated into the posterior mediastinum and an organoaxial gastric volvulus was identified. A repeat EGD and barium swallow at the end of 2024 indicated I now had a large hiatal hernia with the entire stomach located in the posterior mediastinum with a chronic mesenteric axial gastric volvulus without obstruction of the gastric outlet. My obvious concern is that it goes from chronic to acute volvulus and from elective to emergency surgery. But like you, I am not anxious to have surgery. I was wondering if you are still managing it or if you had the surgery?

My stomach was laying on my lungs and heart, causing breathing problems and an erratic heartbeat. My gastroenterologist sent me to a specialist in Indy, who did a Nissan fundoplication. Because of prior problems w/ gastroparesis, I think a less extreme method would have been better. But thanks to an attentive dr. and paying attention to my diet to avoid too much fiber (I will never eat oatmeal again!) I'm now in pretty good shape.
I also lost about 45 pounds, and have kept it off for 2 years now, due to having a smaller stomach.

I have read that it is dangerous to fly with a large hernia because the air pressure could make it rupture. Is this true as I have a very large ventral hernia and a wedding to fly to in March?

I have a stomach that is 100% migrated above my diaphragm. Fortunately I've been a Mayo patient since 2013 and they reviewed radiology scans and confirmed this herniation dated back to 2017. I knew that I was having acid reflux, but rather than resort to drugs, I simply quit eating dinner. That solved the acid reflux problem. I stopped eating about 3pm most days and ate earlier in the day. Today I eat between 6am and 2pm in an 8 hour window. About five years ago, I developed excruciating shoulder pain when I ate too much (think 10/10). The stomach was pressing on phrenic nerve which runs under the clavicle and had absolutely no response to pain killers. Luckily, once we determined it was referred pain from the stomach, it was also easily addressed by lifestyle modification. Less food intake, particularly any bread/grain products. I talked to a surgeon at Mayo and he recommended not undergoing surgery unless I have more serious symptoms and felt at this junction - nearly 8 years later - that it is remote I'll ever have an emergency. So far, so good. I am 73 and am forced to watch my diet or else the shoulder pain sets off. I've lost about 30 pounds, but could easily lose another 70 without getting "too skinny" or endangering my health. Obesity is a leading cause of death, so having this intrathoracic stomach has ironically been helpful for weight loss. I try to look at the bright side of this rare condition and have lived with it now for eight years. No doctor had ever seen referred shoulder pain from overeating before - but it is very real and hurts like the dickens. So I am very motivated to eat less and NO bread! The phrenic nerve thankfully sends a very mild "advance warning" signal when I am overeating so I know that I literally can't take another bite - and also reliably vanishes once the food is digested (2-8 hours) fortunately. But I went for 5 years wondering what was causing my left shoulder to periodically hurt so bad. Lots of medical exploration and nothing. I ultimately had to figure it out for myself after seeing a chart showing the phrenic nerve running directly under the clavicle. Mystery solved! I would avoid any surgery, particularly abdominal surgery, if you can. Particularly if you are over age 65, like me. Our bodies are beautifully designed and my only life changing injuries in life were caused by two surgeries (1) a misplaced unnecessary kidney stent that hurt my bladder before a kidney stone removal and 2) a premature cataract surgery on my best 20/20 eye - ouch!) We have to live in our bodies, so it is wise to be protective of them. Good luck.