Hiatal Hernia Neck Pain: Understanding Isolated Head and Neck Symptoms
How does hiatal hernia cause neck pain. What are the common symptoms of hiatal hernia in the head and neck region. Can hiatal hernia cause hoarseness and throat discomfort. How is hiatal hernia with neck symptoms diagnosed and treated. Why do some patients with hiatal hernia experience primarily head and neck symptoms.
The Surprising Link Between Hiatal Hernia and Neck Pain
Hiatal hernia, a condition typically associated with digestive issues, can surprisingly manifest as isolated head and neck symptoms. This unexpected connection challenges traditional understanding of the disorder and highlights the importance of considering hiatal hernia in patients presenting with unexplained throat, neck, or ear discomfort.
A study published in JAMA Otolaryngology–Head & Neck Surgery revealed that out of 22 patients diagnosed with hiatal hernia and reflux, 21 experienced hoarseness or foreign-body sensation in the throat. Remarkably, many of these patients did not exhibit the usual gastrointestinal symptoms commonly associated with hiatal hernia.
Decoding the Symptoms: When Hiatal Hernia Affects the Neck
The spectrum of head and neck symptoms associated with hiatal hernia can be diverse and perplexing. Patients may experience:
- Foreign-body sensation in the throat
- Hoarseness
- Neck pain
- Otalgia (ear pain)
- Intractable cough
These symptoms can be particularly troublesome as they may lead to misdiagnosis or delayed treatment if hiatal hernia is not considered as a potential cause.
Why Does Hiatal Hernia Cause Neck Pain?
The mechanism behind hiatal hernia-induced neck pain involves the complex interplay between the digestive and nervous systems. When the upper part of the stomach protrudes through the diaphragm, it can lead to acid reflux. This reflux may irritate the esophagus and trigger referred pain in the neck region through shared nerve pathways.
Diagnosing Hiatal Hernia with Atypical Presentations
Identifying hiatal hernia as the root cause of isolated head and neck symptoms requires a high index of suspicion and a comprehensive diagnostic approach. Physicians may employ various techniques to confirm the diagnosis:
- Thorough medical history and physical examination
- Barium swallow studies
- Upper endoscopy
- pH monitoring
- Esophageal manometry
The challenge lies in recognizing the potential link between seemingly unrelated symptoms and hiatal hernia, especially when classic gastrointestinal complaints are absent.
Treatment Approaches for Hiatal Hernia-Related Neck Pain
Managing hiatal hernia with predominant head and neck symptoms often focuses on addressing the underlying reflux and hernia. The study reported that 21 out of 22 patients found relief through medical therapy aimed at treating hiatal hernia and reflux. Treatment options may include:
- Lifestyle modifications (e.g., dietary changes, weight loss)
- Antacids and acid-suppressing medications
- Prokinetic agents to improve gastric motility
- Elevation of the head of the bed
- Surgical intervention in refractory cases
It’s worth noting that one patient in the study required surgical intervention, highlighting the importance of tailored treatment approaches based on individual patient responses.
The Role of Interdisciplinary Care in Managing Atypical Hiatal Hernia
Given the complex nature of hiatal hernia presenting with isolated head and neck symptoms, a multidisciplinary approach to care can be beneficial. Collaboration between otolaryngologists, gastroenterologists, and primary care physicians can ensure comprehensive evaluation and management of these patients.
When to Suspect Hiatal Hernia in ENT Practice
Otolaryngologists should consider hiatal hernia as a potential diagnosis in patients presenting with persistent throat discomfort, hoarseness, or neck pain, especially when conventional ENT evaluations yield unremarkable results. Maintaining a high level of suspicion can lead to earlier diagnosis and more effective treatment.
Exploring the Pathophysiology of Atypical Hiatal Hernia Symptoms
The exact mechanisms underlying the manifestation of isolated head and neck symptoms in hiatal hernia are not fully understood. Several theories have been proposed to explain this phenomenon:
- Vagus nerve irritation
- Referred pain through shared nerve pathways
- Microaspiration of gastric contents
- Laryngopharyngeal reflux
Further research is needed to elucidate the precise pathophysiological processes involved in these atypical presentations.
Implications for Clinical Practice and Patient Care
The recognition of isolated head and neck symptoms as potential manifestations of hiatal hernia has significant implications for clinical practice:
- Expanded differential diagnosis for throat and neck complaints
- Improved patient outcomes through targeted treatment
- Reduced need for unnecessary diagnostic procedures
- Enhanced collaboration between medical specialties
- Increased awareness of atypical presentations of common conditions
By considering hiatal hernia in the differential diagnosis of persistent head and neck symptoms, clinicians can provide more comprehensive and effective care to their patients.
Future Directions in Research and Management
The findings of this study open up new avenues for research and clinical investigation. Some potential areas of focus include:
- Identifying predictive factors for atypical hiatal hernia presentations
- Developing targeted screening protocols for high-risk patients
- Exploring novel therapeutic approaches for managing reflux-related head and neck symptoms
- Investigating the long-term outcomes of patients with atypical hiatal hernia presentations
- Examining the potential role of neuroplasticity in symptom manifestation
As our understanding of the complex relationship between hiatal hernia and head and neck symptoms evolves, it is likely that diagnostic and treatment strategies will continue to be refined and improved.
The Importance of Patient Education
Educating patients about the potential link between hiatal hernia and head and neck symptoms is crucial. Many individuals may not associate their throat discomfort or neck pain with a digestive disorder, potentially delaying seeking appropriate medical attention. Healthcare providers should emphasize the importance of reporting all symptoms, even those that seem unrelated, to ensure a comprehensive evaluation.
Challenges in Diagnosing Atypical Hiatal Hernia Presentations
Identifying hiatal hernia as the underlying cause of isolated head and neck symptoms presents several challenges for healthcare providers:
- Lack of awareness about atypical presentations
- Overlapping symptoms with other common ENT conditions
- Absence of classic gastrointestinal complaints
- Limited availability of specialized diagnostic tools in some settings
- Potential for misdiagnosis or delayed diagnosis
Overcoming these challenges requires a combination of clinical acumen, interdisciplinary collaboration, and ongoing medical education to raise awareness about atypical presentations of hiatal hernia.
The Role of Advanced Imaging in Diagnosis
While traditional diagnostic methods such as barium swallow studies and endoscopy remain essential, advanced imaging techniques may play an increasingly important role in identifying hiatal hernias with atypical presentations. High-resolution manometry and impedance-pH monitoring can provide valuable insights into esophageal function and reflux patterns, aiding in the diagnosis of complex cases.
Tailoring Treatment Approaches for Atypical Hiatal Hernia
Managing hiatal hernia with predominant head and neck symptoms may require a nuanced approach to treatment. While standard anti-reflux measures form the cornerstone of therapy, additional considerations may include:
- Voice therapy for patients with persistent hoarseness
- Targeted pain management strategies for neck discomfort
- Behavioral modifications to reduce reflux episodes
- Close monitoring of symptom progression and treatment response
- Consideration of surgical options in refractory cases
Individualized treatment plans that address both the underlying hiatal hernia and its specific symptomatic manifestations are crucial for optimal patient outcomes.
The Potential Impact of Hiatal Hernia on Quality of Life
Chronic head and neck symptoms resulting from hiatal hernia can significantly impact a patient’s quality of life. Persistent throat discomfort, hoarseness, and neck pain may interfere with daily activities, work performance, and social interactions. Recognizing and addressing these quality of life issues should be an integral part of the management approach for patients with atypical hiatal hernia presentations.
Emerging Therapies and Future Perspectives
As research in this field progresses, new therapeutic approaches for managing hiatal hernia with atypical symptoms are likely to emerge. Some promising areas of investigation include:
- Novel pharmacological agents targeting specific aspects of reflux
- Minimally invasive surgical techniques for hiatal hernia repair
- Neuromodulation therapies for managing referred pain
- Personalized medicine approaches based on genetic and physiological profiles
- Integration of artificial intelligence in diagnostic and treatment algorithms
These advancements hold the potential to revolutionize the management of hiatal hernia and its diverse symptomatic presentations.
The Importance of Long-term Follow-up
Given the chronic nature of hiatal hernia and the potential for symptom recurrence or evolution, long-term follow-up is essential for patients presenting with atypical head and neck symptoms. Regular assessments can help identify changes in symptom patterns, evaluate treatment efficacy, and make timely adjustments to management strategies as needed.
Conclusion: A Paradigm Shift in Understanding Hiatal Hernia
The recognition of isolated head and neck symptoms as potential manifestations of hiatal hernia represents a significant paradigm shift in our understanding of this common condition. This expanded perspective challenges healthcare providers to think beyond traditional diagnostic boundaries and consider the complex interplay between different organ systems in symptom manifestation.
By maintaining a high index of suspicion for hiatal hernia in patients presenting with persistent throat discomfort, hoarseness, or neck pain, clinicians can ensure timely diagnosis and appropriate management. The multidisciplinary approach to care, coupled with ongoing research and advancements in diagnostic and therapeutic modalities, holds promise for improving outcomes for patients with atypical presentations of hiatal hernia.
As our knowledge in this area continues to evolve, it is crucial for healthcare providers across various specialties to stay informed about the latest developments and incorporate this expanded understanding of hiatal hernia into their clinical practice. By doing so, we can enhance patient care, reduce diagnostic delays, and ultimately improve the quality of life for individuals affected by this complex and often misunderstood condition.
Isolated Head and Neck Symptoms Due to Hiatus Hernia | JAMA Otolaryngology–Head & Neck Surgery
Isolated Head and Neck Symptoms Due to Hiatus Hernia | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Article
November 1970
John D. Hallewell, MD; T. Boyce Cole, MD
Author Affiliations
Washington, DC; Durham, NC
From the Section of Otolaryngology, Malcolm Grow USAF Medical Center, Washington, DC (Dr. Hallewell), and Duke University Medical Center, NC (Dr. Cole).
Arch Otolaryngol. 1970;92(5):499-501. doi:10.1001/archotol.1970.04310050081012
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Abstract
Symptoms of foreign-body sensation in the throat, hoarseness, neck pain, otalgia, or intractable cough were found in 22 patients with hiatus hernia and reflux. Of these, 21 had hoarseness or foreign-body sensation. The usual symptoms of hiatus hernia were often absent. With medical therapy for hiatus hernia and reflux, 21 obtained relief. One required surgical intervention.
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Hiatus Hernia FAQs (Frequently Asked Questions)
These are questions we are often being asked specifically on Hiatus Hernia, together with our answers. It should be read in conjunction with the page specifically on Hiatus Hernia.
Nothing here is to be taken as medical advice. If in any doubt at all, please consult your family doctor in the first instance.
My last attack lasted 6 hrs and the pain was so bad I thought I was having a heart attack. When does a hiatus hernia become dangerous?
The symptoms can mimic those of a heart attack well enough to fool many a doctor. The excruciating pain, the pain in the jaw, the left arm – classic signs. Most unpleasant. Of course, as it is not a heart attack, that in itself is not as dangerous at all. The worst danger facing most sufferers relates to reflux. That is where the stomach contents are squeezed up into the oesophagus, aka the gullet or ‘food pipe’. That can cause two really dangerous issues:
- The reflux material can come up the oesophagus and be aspirated (breathed back in), down the airways. That alone is bad enough, but being acidic, it can trigger a horrible spasm rendering the sufferer unable to clear the airway. .
- The acid burning the oesophageal lining over extended periods can cause permanent damage to the tissue, sometimes change the nature of the cells and lead to other very nasty conditions.
Aspirating reflux is possibly the most ‘dangerous’ risk of untreated Hiatus Hernias as it can be fatal. Note though that reflux can arise from causes other than Hiatus Hernia.
Best advice: If you suffer long-term heartburn or indigestion, or prolonged attacks of reflux (awake or asleep) consult your family doctor. He may well refer you to a gastro-enterologist for tests to establish the cause and recommend treatment before it becomes a serious danger.
How long before bed to stop eating would be a nice guide.
I’m sitting here at 4am after just waking with yet another bout of reflux and it was hours ago I last ate. Great page, thank you!
For what to eat and when, ‘little and often’ tends to alleviate symptoms best in most cases. Sadly, even a glass of water before bed can bring it on. If you are having such reflux not having eaten for ‘hours’, then make an appointment to see your family doctor now. Yours is a case in need of proper investigation.
Would be nice to have a link to somewhere (if there is anywhere!) that tells you what to look out for after so much acid burning the throat so many times and aspirating the acid.
First of all, ‘acid burning your throat so many times’ and ‘aspirating the acid’ are BOTH serious symptoms (see the first FAQ above).
Understand that burning really is BURNING. If you look down an endoscope you would see the signs of actual burns. This is very serious and you MUST stop it from continuing.
For immediate relief, many sufferers find products like Gaviscon very effective. However, this is NOT a long term solution to what you describe AT ALL! Your doctor IS.
Surgery for a hernia of the esophagus in Moscow at the Clinical Hospital on Yauza
You can get this service free of charge under the CHI policy, call
+7 (495) 234 42 42
Book an operation for hiatal hernia
Bilingual service: Russian, English.
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Contents
IMPORTANT!
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
Hiatal hernia of the diaphragm occurs in 40% of the adult population of Russia. However, in many cases, it is asymptomatic, diagnosed by chance during routine examinations. Symptoms of a hernia are often confused with other pathologies, choosing the wrong therapy. Meanwhile, this condition is quite dangerous, without proper treatment can cause a number of complications. At the Clinical Hospital on Yauza, a thorough examination is carried out to identify pathologies, and experienced specialists select the most effective therapy.
Hiatus hernia: what is it
Pathology develops as a result of stretching of the fascial ligaments between the opening of the diaphragm, through which the esophagus passes, and the esophagus itself. As a result, the organs are partially displaced into the chest. The disease can be congenital or develop with age.
Depending on the stage of development of the disease, the shift may not be constant, but appear under certain factors (cough, overeating, physical activity). Hernia of the esophagus is defined by two types:
- sliding;
- paraesophageal.
Both types of pathology require mandatory treatment. Without proper therapy, the patient may develop perforation, bleeding, and organ entrapment.
Guidelines for hiatal hernia: surgery and conservative management
When a pathology is detected, treatment is prescribed depending on its size and characteristics of the course. Medication methods for the treatment of a hernia of the esophageal part of the diaphragm or surgery are used.
The conservative method does not lead to a complete recovery. It is prescribed for small hernias, if there are no risks of complications. The goal of medical treatment is to relieve symptoms. For this, the patient is prescribed a special diet that excludes spicy, fatty and heavy foods, alcohol. Recommend fractional meals in small portions. To relieve pain and other symptoms, prescribe:
- prokinetics;
- antacids;
- antispasmodics.
Hiatus hernia operation
Surgery for hiatal hernia is the only effective method to eliminate pathology. At the Yauza Clinical Hospital, laparoscopic surgeries are performed to correct the problem. The method is minimally invasive, practically does not cause complications. The unique technique used by the doctors of the clinic reduces the risk of recurrence of the pathology.
Through small punctures, the supply of instruments to the surgical field is ensured. The surgeon returns the tissues to an anatomically correct position. Then a “cuff” is formed, which strengthens the wall of the esophagus. This prevents re-displacement of organs.
The procedure is performed under general anesthesia. After surgery for a hernia of the esophageal opening of the diaphragm, performed laparoscopically, the patient does not experience pain. Due to the minimally invasive intervention, postoperative discomfort is maximally reduced, it is easily stopped by painkillers.
Surgery for hernia of the esophagus in Moscow
Patients of the Clinical Hospital on the Yauza receive high-quality treatment at a European-level medical center. The clinic is equipped with the latest medical equipment. Experienced specialists have unique innovative methods of hernia treatment.
The clinic provides comprehensive services. Here you can undergo a complete examination in order to establish the cause of the development of the pathology and choose the most effective treatment.
The postoperative period patients spend in a comfortable hospital. Upon discharge, they receive detailed recommendations on further treatment and rehabilitation period.
The cost of surgery for a hernia of the esophageal opening of the diaphragm does not exceed the average rates in the region. The clinic provides a lot of medical services as part of the CHI.
The exact prices for hiatal hernia operations are indicated in the price list of the clinic. You can also clarify the cost of services during a consultation with a surgeon.
Sign up for a procedure
Attention! Website prices may vary.
Please check the current cost with the administrators by phone.
Cancer of the esophagus
I. Sliding (axial) hiatal hernia
- esophageal (only the esophagus is mixed into the mediastinum)
- cardiac;
- cardiofundal;
- subtotal gastric;
- total gastric.
II. Paraesophageal hernias
- fundic;
- antral;
- enteric;
- gastrointestinal;
- stuffing box.
SYMPTOMS OF HIAPHATHERAL HERNIATION
- Heartburn – at the beginning of the disease occurs after errors in the diet or after abundant food, in the later stages it bothers patients almost constantly. Cha most often in the region of the chest, neck, shoulder blades.
- Pain in the epigastrium and retrosternal region of aching and pulling character, occurs after eating, is greatly reduced or disappears from taking antacids.
- Eructation , usually air or sour, occurs after eating and brings some relief.
- Regurgitation , more often determined when bending over, and also at night in a horizontal position.
- Dysphagia is a non-permanent symptom that occurs more often when hot or too cold food is swallowed.
- Pain – burning tongue, stomatitis, damage to tooth enamel.
- Laryngitis and pharyngitis
- Cough , dry, exhausting, often accompanied by symptoms of chronic bronchitis or pneumonia.
- Chest pain, often accompanied by extrasystoles.
DIAGNOSTICS OF HERNIAS OF THE HIGH-DIAPHRAGM
X-ray examination
X-ray method is one of the leading methods in the diagnosis of diseases of the esophagus and stomach. This safe and completely physiological method will allow to study with great certainty the topography, anatomical structure and functional state of the esophagus and stomach, gastroesophageal reflux. The study is carried out in the morning, on an empty stomach. Contrasting of the esophagus should begin with the use of conventional liquid barium suspension (100 g of barium sulfate in 100 g of water). Sometimes a more liquid contrast mass is used to better identify hiatal hernia and reflux.
X-ray examination in most cases allows to detect or confirm gastroesophageal reflux in patients with physiological cardia insufficiency. Indirect signs of a hernia of the esophageal opening of the diaphragm are often determined already with a non-contrast study. This is an additional shadow in the posterior mediastinum with enlightenment in the center or the level of the liquid, one or two (“hourglass”) gas bubbles against the background of the heart; expansion of the mediastinum with a clear outer contour; changes in the size, shape and position of the gastric bladder and others.
The main fluoroscopic symptoms in patients with cardia insufficiency are the throwing of barium suspension from the stomach into the esophagus, obtuse esophageal-gastric angle, relaxed cardia tone. In addition, attention is drawn to the reduction or disappearance of the gas bubble of the stomach, elongation or arcuate curvature of the supraphrenic part of the esophagus. The detection of more than three mucosal folds in the supraphrenic esophagus indicates their belonging to the gastric mucosa. In some patients, thickening and deformity of the gastric fornix, as well as changes in the tone and motility of the esophagus with registration of hyperkinesia and antiperistaltic movements of the contrast are detected.
Various x-ray methods are used to detect cardiac insufficiency. Most of them are based on an increase in intra-abdominal pressure. Such methods include examining the patient on a trochoscope in the Trendelenburg position. The patient lies on his stomach or on his back. An inflated balloon is sometimes placed under the abdomen. When examining a patient in an upright position after taking a barium suspension, he is asked to lean forward or squat down. At the same time, it is possible to ascertain gastroesophageal reflux. An increase in intra-abdominal pressure is facilitated by coughing, straining the abdomen, Valsalva’s test, lifting the legs up and so on. However, not everyone agrees with the use of such methods, for example, D.I. Tamulyavichute (1986) believes that such an increase in intra-abdominal pressure is antiphysiological and leads to overdiagnosis. It is more expedient, according to the author, to use pharmacoroentgenography – artificial hypotension with atropine, which makes it possible to detect even small sliding hernias.
The radiological signs of hiatal hernia include: penetration of part of the stomach into the posterior mediastinum above the level of the diaphragm; gastric folding (more than 3) in the esophageal opening of the diaphragm and above it; arcuate course and tortuosity of the esophagus. These symptoms of a sliding hernia of the esophagus are determined only in a horizontal position. In the upright position of the patient, all parts of the stomach take their usual position, while the mucosal edema remains. Sometimes signs of prolapse disappear when the stomach is inflated with air. Edema of the cardia, fornix, migration of the cardia of the stomach and prolapse of the mucous membrane of the authors (I.L. Tager, A.A. Lipko, 1965) are classified as reliable and “pathognomonic” symptoms of hiatal hernia. With shortening of the esophagus, the part of the stomach that has moved into the chest cavity remains in the upright position of the patient. In the horizontal position of the patient, the size of the hernia may increase.
When invagination of the esophagus is observed x-ray symptom of the “collar”, described by GI Vanshtein (1963). The walls of the stomach, surrounding the intruding esophagus, resemble a collar worn around the neck. In the differential diagnostic respect, it should be remembered that a hernia of the esophageal opening of the diaphragm may resemble a supraphrenic ampulla (a symmetrical expansion of the supraphrenic esophagus that appears and disappears during swallowing). It is distinguished from a hernia by smooth and clear contours, the appearance at the time of the passage of barium suspension through the esophagus, and not when barium is thrown from the stomach into the esophagus, thin and delicate folds of the esophagus, the absence of reflux and hernial gates, as well as clinical symptoms.
ENDOSCOPIC EXAMINATION
Endoscopic examination in reflux esophagitis shows the severity of inflammatory changes in the esophagus. The study is especially indicated for reasonable suspicion of a combination of hiatal hernia with a tumor or other diseases of the esophagus, in all patients with chronic anemia and with peptic stricture of the esophagus.
With reflux esophagitis, the mucosa of the esophagus appears hyperemic, edematous, loose, easily bleeding, erosions and ulcerations are determined. It should be noted that erosions are single and multiple.
Esophagitis in most cases is limited to the lower third of the esophagus. During the study, as a rule, the border between healthy and affected mucosa is visible. In some patients, esophagitis extends to the level of the aortic arch. The severity of esophagitis in all cases increases in the aboral direction, and the most severe changes are determined in the area of the cardia. The normally visible demarcation border between the mucous membranes of the esophagus and stomach is not determined with severe esophagitis.
More than 60% of the patients examined by us revealed pathological changes in the hernial part of the stomach in the form of hyperemia, swelling and tortuosity of the folds, bleeding when touched by the instrument.
During the examination, it is important to establish the condition and position of the cardia. The height of the standing cardia is determined by the distance to it from the incisors of the upper jaw. We take the minimum length of a normal esophagus as 39.5 cm. If the cardia was located at a distance of 37-39 cm, then this is the I degree of shortening, if less than 37 cm – shortening of the esophagus of the II degree (when determining the degree of shortening, the patient’s height should be taken into account).
Changes in the mucosa in moderate reflux esophagitis were limited to the lower, less often the middle third of the esophagus. The esophagus is dilated, the mucous membrane in the zone of inflammation is sharply hyperemic, bleeds easily when touched. In the supracardial esophagus, both single and multiple erosions were determined. Defects in the mucous membrane often had an oval, rarely round shape. Occasionally, fibrinous plaque and segmental spasm in the area of inflammation were determined.
Fibrinous and ulcerative changes in reflux esophagitis are characterized by pronounced manifestations. Usually, starting from the middle third of the esophagus, there are changes characteristic of mild esophagitis. Gradually, the phenomena of esophagitis increase in the distal direction. In the lower third of the esophagus, pronounced erosions and ulcerations are noted, covered with fibrinous plaque and necrotic films, which are easily removed by the instrument. In this case, the mucous membrane bleeds, which makes it difficult to examine.