Paraesophageal Hernia - less common, but it is more cause for concern. The esophagus and stomach stay in their normal locations, but part of the stomach squeezes through the hiatus, placing it next to the esophagus. Although this type of hernia can exist without any symptoms, the danger is that the stomach can become "strangled," which means its blood supply is cut off.
Often, people with a hiatal hernia also have heartburn or gastroesophageal reflux disease (GERD). Although there is a link, one condition does not necessarily cause the other, because some people can have a hiatal hernia without having GERD, and vice versa.
A hiatal hernia can be diagnosed with a barium study, a special X-ray that allows visualization of the esophagus, or with esophagoscopy, a procedure in which the upper digestive system is examined with an endoscope (long-thin flexible instrument).
If the hiatal hernia is complicated by severe symptoms of GERD, trouble swallowing, pain, gastrointestinal bleeding with anemia, and recurrent pneumonias, or if the symptoms and tests suggest that a paraesophageal hernia (part of the stomach squeezes through the hiatus) may be present, surgery may be recommended. The endoscopy can provide an accurate diagnosis and treat the bleeding area, when present.