Hiatal Hernia?

[RJMonahan]

I recently was suffering from tightness and a burning sensation in my chest and a sharp pain in my back under my left shoulder blade.  Although I am a 45 year old male, I did not think it was possible that this discomfort was caused by heart disease as I am very active.  There has been tenderness under my breast plate, and I recall receiving a sharp blow to the chest several months ago in a basketball game and was surprised it had not healed. I ran on my treadmill for 30 minutes near Max HR to confirm that I could push myself and felt that if heart disease was significant I would not be able to run to that extreme.  

I came across the site for Hiatal Hernia and noticed that I seem to have symptoms. The tenderness at and under my breast plate, and the indigestion, and often times sick feeling that lasts for a day or two after I eat a large meal.

My question is this:  Is it possible I developed this from the sharp blow to my chest, and if so what doctor, or type of doctor should I see first to confirm this abnormality, and finally would surgery be a consideration for long term relief?

[Kevin Pho, MD]

The repetitive stress of swallowing as well as that associated with abdominal straining and episodes of vomiting make the area of the hiatal hernia prone to weakness.  Chronic GERD also causes weakness of the paraesophageal membrane, perhaps leading to the hernia.  It is less likely that a sharp blow to the chest would lead to a hiatal hernia.

An upper GI series or upper endoscopy would be the appropriate test to evaluate this.  The treatment would depend on what kind of hernia is present.  The most common type of hiatal hernia (known as a sliding hiatal hernia - it presents in 95% of cases) does not require surgery.  If the hernia is one of the other types (as seen on the upper endoscopy), then surgery may be considered.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Kahrilas.  Hiatus hernia.  UptoDate, 2004.

[RJMonahan]

OK; sometimes reading the question helps in preparing an answer.  There was no mention of vomiting in the original question.  But hey, it's my $16!