Which of the following symptoms is typically NOT associated with a paraesophageal hiatus hernia?

In the context of a paraesophageal hiatus hernia, the correct choice indicates that gastric or acid reflux is typically not a symptom associated with this type of hernia. A paraesophageal hernia occurs when part of the stomach pushes through the diaphragm alongside the esophagus and sits next to it in the chest cavity, which can lead to complications but does not primarily cause acid reflux.

The mechanism behind reflux involves the lower esophageal sphincter (LES) and is more likely associated with sliding hiatal hernias, where the stomach and the junction between the esophagus and stomach move above the diaphragm. In the case of a paraesophageal hernia, the LES function may remain intact, reducing the likelihood of experiencing classic acid reflux symptoms.

Retrosternal pain can be a symptom since the hernia can irritate surrounding tissues or organs, causing discomfort in the chest region. Cardiac ischemia is also not directly related to the hernia itself, but its symptoms may overlap with those of a paraesophageal hernia, thus causing confusion in diagnosis. Vomiting and nausea can occur if the herniated stomach becomes obstructed or twisted. Therefore, gastric or acid reflux is the least likely symptom associated specifically with a paraesophageal hiatus her