Bloating From Acid Reflux? It Might Be Related to a Paraesophageal Hernia

If you experience bloating that makes your clothes feel tighter and more uncomfortable every time you have an acid reflux episode, you might have a paraesophageal hernia. The condition is more common in those over 50, but adults of any age often develop this type of hiatal hernia. Bloating is commonly a symptom of acid reflux, also known as gastroesophageal reflux disease (GERD).

 

GERD, another term for gastroesophageal reflux disease, is a chronic condition in which stomach acid flows back into the esophagus, causing irritation and damage to the lining of the esophagus. Over-the-counter meds like antacids, proton pump inhibitors, and beta blockers can provide immediate yet temporary symptom relief. But if you experience bloating several times a week or more with acid reflux accompanied by pain, medical treatment is necessary to treat the underlying cause and provide long-term relief.

Continue reading to learn more about the connection between acid reflux, bloating, and paraesophageal hernias and suitable treatment options.

What Is a Paraesophageal Hernia?

Hernias can occur anywhere in the areas of the body where the connective tissues and muscles separate or become weak enough to allow the organs and contents underneath to push through. Paraesophageal hernias, also known as hiatal hernias, occur when the upper portion of the stomach bulges through the abdominal muscles into the chest via an opening in the diaphragm. They also commonly occur in areas where the connective tissues are thinnest or weakest, usually from previous surgeries or injuries.

In many cases, hernias are painless swellings that don’t cause noticeable symptoms or require immediate medical attention. Paraesophageal hernias, on the other hand, are serious and almost always require surgery to alleviate the pain, discomfort, and complications. 

What Does Bloating Have to Do With Paraesophageal Hernias?

A paraesophageal hernia bulges into the chest and pushes upward into the esophagus, entrapping a portion of the stomach for gastric acid to collect and irritate the esophagus. The ring-shaped muscle at the bottom of the esophagus, the sphincter, connects to the stomach. This muscle relaxes to let food into the stomach and immediately tightens to keep the contents from leaking. When the sphincter malfunctions, stomach acid backs up into the esophagus, causing heartburn. 

The esophagus is not designed for prolonged or frequent exposure to acidic contents of the stomach. If reflux is not treated, it can lead to other health problems. Acid reflux also causes gas in the stomach and intestines and is often noticeable as swelling and bloating. Some people also have chest pain and trouble swallowing.

Paraesophageal Hernia Risk Factors

Hernias are common, but some individuals are more susceptible to developing them than others. Paraesophageal hernia risk factors include:

• Age – people over the age of 50 have the highest risk of all age groups
• Gender – the condition is more common in women than in men
• Obesity – being overweight increases pressure on the diaphragm
• Smoking – smokers are more prone to the condition than non-smokers
• Chronic coughing – coughing increases pressure on the diaphragm
• Connective tissue disorders – conditions like Ehlers-Danlos syndrome or Marfan syndrome
• Prior surgery – old incisions around the diaphragm

Not everyone with this type of hernia has these risk factors, and many at-risk individuals never develop the condition. The only way to know for certain is to schedule an appointment for acid reflux treatment in Orange County, CA, to get an official diagnosis.

 

How Do I Know if Bloating Is from GERD or a Hernia?

GERD and paraesophageal hernias share many symptoms, which makes self-diagnosis difficult. Here is a general guide to help you understand the differences:

Symptom: Bloating after eating

More likely GERD: Bloating that improves with antacids or burping

More likely Paraesophageal Hernia: Bloating that is persistent and does not respond to over-the-counter medications

Symptom: Heartburn / acid taste

More likely GERD: Occurs frequently, especially at night or when lying down

More likely Paraesophageal Hernia: Heartburn that is severe, accompanied by chest pressure or difficulty swallowing

Symptom: Chest discomfort

More likely GERD: Burning sensation, may mimic heart pain

More likely Paraesophageal Hernia: Pressure or fullness in the chest after eating, shortness of breath

Important: The only reliable way to distinguish these conditions is with imaging. An upper endoscopy or barium swallow study can confirm a hiatal or paraesophageal hernia.

 

What Other Symptoms Besides Acid Reflux and Bloating Do Paraesophageal Hernias Cause?

Bloating and acid reflux aren’t the only signs of a potential hiatal hernia, and in many cases, they are similar to those that occur from gastroesophageal reflux disease. Additional symptoms often include the following:

• Heartburn
• Chest pain
• Difficulty swallowing (dysphagia)
• Regurgitation
• Belching or hiccups
• Nausea or vomiting
• Coughing
• Voice hoarseness
• Shortness of breath

It is also common for some individuals to have paraesophageal hernias without symptoms. If you have any of these symptoms, it is important to see a hernia repair specialist for acid reflux treatment in Orange County, CA, to determine the cause and to receive appropriate treatment.

Paraesophageal Hernia and Acid Reflux Treatment in Orange County, CA

Hernia repair specialists recommend the following treatment options for acid reflux and paraesophageal hernias.

Diet changes: Eating too quickly and too much, along with certain foods and drinks, such as carbonated beverages, beans, and cruciferous vegetables, contribute to bloating and acid reflux.

Medications: Over-the-counter antacids and acid reducers, such as proton pump inhibitors (PPIs) or H2 blockers, can help relieve symptoms for some individuals.

Laparoscopic surgery: A minimally invasive procedure that uses small incisions and a laparoscope (a thin, lighted tube) to repair hernias. The procedure is also commonly performed robotically with an advanced robotics surgical system. The surgeon pushes the bulging contents back into the abdomen and then repairs the diaphragm with sutures or mesh. This procedure is less invasive than open surgery and has a shorter recovery time.

Open surgery: The surgery requires a large incision across the abdomen to access the hernia. The rest of the procedure is performed similarly to laparoscopic surgery but is typically reserved for larger hernias and individuals who do not qualify for laparoscopic surgery.

Nissen fundoplication: The surgery involves wrapping a portion of the stomach around the lower esophagus to create a new valve to prevent stomach acid from flowing back into the esophagus. This procedure is typically recommended for individuals with severe acid reflux or GERD symptoms.

Treatment is determined by the size, complexity, and location of the paraesophageal hernia, the patient’s health profile, and other factors. A consultation is necessary to ensure patients are properly vetted for the most suitable procedure to improve their situation.

If you experience persistent bloating and acid reflux, contact Dr. Abtin Khosravi, MD, at Orange County Robotics General Surgery to learn appropriate treatment options for your paraesophageal hernia.

 

Frequently Asked Questions

Q: Can acid reflux cause a hernia?

A: Chronic acid reflux (GERD) does not directly cause a hernia, but the two conditions are often related. A hiatal hernia — where the stomach pushes through the diaphragm — is a common underlying cause of severe GERD. Additionally, repeated retching or vomiting from GERD can weaken the diaphragm over time. Treating the hernia often significantly improves acid reflux symptoms.

Q: What is the treatment for a paraesophageal hernia?

A: Paraesophageal hernias almost always require surgical repair because they carry a risk of serious complications, including stomach rotation and strangulation. Surgery typically involves reducing the herniated stomach back into the abdomen, repairing the diaphragmatic defect, and often performing a fundoplication to prevent future reflux. Dr. Khosravi performs this procedure using minimally invasive robotic techniques at Orange County Robotic Surgery.

Q: Is bloating always a sign of a hernia?

A: Not necessarily. Bloating has many causes, including GERD, food intolerances, IBS, and functional dyspepsia. However, persistent bloating that is accompanied by chest pain, difficulty swallowing, or regurgitation — especially if it does not respond to diet changes or antacids — warrants a surgical evaluation to rule out a hiatal or paraesophageal hernia.

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