Hiatus Hernia?

[sms747]

The Dr at Bangkok Hospital told me I had an Hiatus hernia yesterday. However due to the effects of the anaesthetic I was not up to asking questions I later thought of. She did not mention surgery to correct it, or if it gets worse. Is keyhole surgery done here and about how much would that be? Also are there any foods to avoid? I remember her advising to cut out coffee and booze but no mention of foods to avoid. Some people get no symptoms with this but it causes me quite a lot of discomfort at time.

[jrtmedic]

I presume you had an endoscopy under sedation, as part of an investigative process for "heartburn" or upper abdominal pain.

Hiatus hernias are indeed common but dont cause problems for the majority of people who will never be aware they have the condition. Problems arise when acid from the stomach gains access to the lower oesophagus (gastroesophageal reflux disease) .

There are some lifestyle measures you can take which include sensible adjustments to diet and alcohol intake. If you carry excess weight then slimming down will help!

Depending on the Drs findings you may be prescribed an antacid +/- a medication such as Zantac (Ranitidine) or Losec (Omeprazole)

Go here for further information http://www.mayoclinic.com/health/hiatal-hernia/DS00099

[Sheryl]

Did the endoscopy also show gastritis? If so, need to treat that, including eradication of H. Pylori if indicated. (They may need to wait for test results to know that.) That you have a hiatus hernia does not necessarily mean it is the main cause of your distress. Only if it is a large one in the absence of gastritis would that be likely.

Surgery is a last resort and often unnecessary.

The usual management is:

1. Avoid caffeine (or minimize it) as this weakens the sphincter between esophagus and stomach, promoting acid reflux.

2. Avoid eating large amounts at one time -- smaller portions and then wait a bto for a second helping if desires. Overfilling the stomach will lead to reflux.

3. Avoid lying down flat for 2 hours after eating.

4. If the problem is mainly at night, an extra pillow may help.

5. A PPI such as omeprazole is often prescribed.

Some good resources:

http://www.mayoclinic.com/health/hiatal-hernia/DS00099

http://www.nhs.uk/Conditions/Hernia-hiatus/Pages/Introduction.aspx

[sms747]

Thanks sheryl I don't know what this forum would do without you.Dr I saw was prof Mahachai. I have been on omerprazole for 11 years anyway for ulcers and heartburn. She suggested some others nexium, pevacid or mohilum. The report says gastritis antrium, no HP though. I might give one of these others a try as the losec does not seem as effective as it was, or it might be the generic ones made i Thailand?

Edited April 14, 2013 by sms747

[Sheryl]

Nexium( esomeprazole) ) and Pevacid (Lansoprazole) are newer drugs in the same class as Omeprazole. The drug companies claim they are better, I have my doubts, they certainly cost more. no harm in trying.

For the third drug I think you mean Motilium. that has a different mode of action, it accelerates emptying of the stomach. The generic name is domperidone and there are many locally made brandfs of it.

Another drug with a totally different mode of action which helps many people is sucralfate. It provides a protective coating to the inflammed gastric mucosa. Its action is totally local, no systemic side effects. Underused IMO. One reason for that may be that it is a slightly unpleasant tasting thick liquid. Several brands in Thailand, the most commonly found being Ulcerfate and Ul;sanic. The Ulsanic apparently comes in a tablet form as well but I find it hard to locate.

No problem with taking sucralfate along with a PPI but should take at different times from other meds as the sucralfate may decrease absorption. Need to use the sucralfate regularly for a long time to see results, but it can definitely aid healing.

Both alcohol and tobacco have been linked to antral gastritis so if you drink or smoke, try to stop or cut back.

I suspect that unless your hiatus hernia is unusually large, it is the antral gastritis that is causing your symptoms.

[sms747]

I will give the sucralfate a try I think, and cut back drinking as that usually makes things worse, thanks.

[Sheryl]

Yes, alcohol is a major culprit for this.

[blowin]

Hi I had a hernia which I had repaired a few years back but was starting to give me trouble a few weeks back which I ignored . But last month the pain was so bad it was making me get sick so I ended up in hospital had a emergency operation for a twisted gut had some of my intestine cut out

and was lucky due to septicemia setting in. This nearly killed me so don't take these things lithely as they can blow up very fast as in my case.

[Sheryl]

It sounds like you had an intestinal hernia. These should indeed be repaired, as the risks associated with the surgery are much less than the risks of having it strangulate, which it sometimes does as it did in your case, at which point it is major medical emergency.

However the OP has a hiatus hernia which is an entirely different thing. It is when the upper part of the stomach slides through the "hiatus" (opening between chest and abdomen which the esophagus passes through). A very high proportion of older people have this and it is usually asymptomatic. At the most, it wlil worsen or predispose to GERD. Surgery is seldom required.

[lvdkeyes]

I have had a hiatal hernia for many years. I take omeprazole every morning and it controls the acid reflux very well.

[Deathlay]

My god i have been suffering the last year and a half with this,on omeprazole(dont help me much)pains in my chest,shortness of breath(which is my worse symptom by far)pains in my gut randomly,food balling up in my throat and general feeling crap all the time.have seen 3 doctors in uk and they all say shortness of breath isnt a symptom but my research tells me differently,i have a note from the hospital saying i need see a hernia specialist but they wont refer me(<deleted>) had the thing down my throat and something put deep in my arse(.have to wait atleast 3 months from seeing doctor to getting any kind of referal to the hospitL and they keep sending me for things i have all ready have had like blood tests and lung capacity tests so now have come to the end of my tether and am now looking in to getting the operation in another country,anyone have any info on how much and which type of opperation they do and best place to get it?any help would be greatly helpful as this is impacting my life greatly.

[jrtmedic]

Deathlay

Sounds as if you have been busy Googleing" !

Seriously though, the vast majority of people with hiatal hernias are managed successfully with conservative (ie non surgical) treatment.

Maybe your case is a little more complex than most which would explain the Doctors wish to investigate your condition thoroughly.

Whilst you may not believe it you are very lucky in being able to access one of the very few health care systems in the world which offer care which is free at the point of delivery.

If you are concerned about your care I would suggest you make an appointment with your GP. I am sure he/she will be able to reassure you and "unblock" any impediment to you receiving appropriate care.

[Sheryl]

It is doubtful that hiatus hernia accounts for all the symptoms you describe and hence unlikely that a repair would help much if at all.

What exactly were the results of the gastroscopy? (tube down the throat test)?

[bunnydrops]

I had that for about 2 years. Tried everything H blockers didn't help (my doctor said " they can't not work"). It didn't matter what I ate or didn't eat. Stated to sleep in chairs (no fun). Tried alternative medicine--nothing helped. It was the only time in my life that I thought suicide was an option. Then one day the wife of a friend of mine, she is a nurse, told me to stop taking everything and just carry a bottle of water, and sip from it, don't drink large amounts as often as you can remember to do so. She said I would never hear that from a doctor. I did what she told me and the symptoms were gone. I still have the hernia, but I haven't had the reflux or heartburn since.(6 years). Maybe it was just luck or timing, but I thought I would pass my experience along

[Deathlay]

Was a 3 cm sliding hiatus hernia,also i dont know if it makes any difference but i also get mucus in my poo.out of all the things i get its the shortness of breath which the doctors just want to put down to depression which i disput strongly.why do all doctors insist that hernia related problems do not cause shortness of breath?and yes i do have to do alot of "googleing"as there is wealth of info on there.i do know that i have to wait 3 months minimum from seeing doctor to having any interaction with the hospital.sorry if i am rambling but im just very frustrated as over the last year and a half i have gone from being a going to the gym 5 times a week to struggling to make it through work..can the breathing problems be lying with the vegas nerve?

[bunnydrops]

My god i have been suffering the last year and a half with this,on omeprazole(dont help me much)pains in my chest,shortness of breath(which is my worse symptom by far)pains in my gut randomly,food balling up in my throat and general feeling crap all the time.have seen 3 doctors in uk and they all say shortness of breath isnt a symptom but my research tells me differently,i have a note from the hospital saying i need see a hernia specialist but they wont refer me(<deleted>) had the thing down my throat and something put deep in my arse(.have to wait atleast 3 months from seeing doctor to getting any kind of referal to the hospitL and they keep sending me for things i have all ready have had like blood tests and lung capacity tests so now have come to the end of my tether and am now looking in to getting the operation in another country,anyone have any info on how much and which type of opperation they do and best place to get it?any help would be greatly helpful as this is impacting my life greatly.

I can't say where to get the operation. In the states it is done in the specialist's office. They stitch a little "knot" in your throat so that nothing can ever come up--- everything goes south from then on. Not sure about burbing but you never throw up again.

[jrtmedic]

If you are seriously considering private treatment you may find that it is as cheap to obtain private advise in the UK.

Good quality heath care in Thailand is no longer "cheap" especially once you take account of air fares and hotel accommodation.

Have a look at the BUPA site here http://www.bupa.co.uk/individuals/health-information/directory/h/hiatus-hernia

[meatboy]

i have suffered with hiatus hernia for 35yrs.till i was put on lansoprazole 30mg.apart from the odd heartburn[self inflicted] its been very good.i went through all the tests in and out of hospital had the tube down my throat so many times i didnt need a relaxent,

i had nearly all the symptoms you are having and for yrs.they said i had a dodenal ulcer but in 1978 they took a sample from my stomach and they came up with hh.have you elavated your bed and if like me a little bit overweight dont wear tight clothing around your waist mainly a belt and avoid bending,they will get it right in the end.all my own doing curies,cider,spicey food and what i consider one of the main causes eating late at night,it is now 7yrs.since i have eaten any meal after 5pm.

[midasthailand]

I had keyhole surgery for Hiatus Hernia at Bangkok Nursing Home (BNH) Soi Convent in 1997. For the next couple of months I could only eat very small portions as if I ate a normal meal I would be in pain for several hours. After a couple of months I was ale to start eating normal portions and since then I have had no problem with reflux pain.

[Sheryl]

My god i have been suffering the last year and a half with this,on omeprazole(dont help me much)pains in my chest,shortness of breath(which is my worse symptom by far)pains in my gut randomly,food balling up in my throat and general feeling crap all the time.have seen 3 doctors in uk and they all say shortness of breath isnt a symptom but my research tells me differently,i have a note from the hospital saying i need see a hernia specialist but they wont refer me(<deleted>) had the thing down my throat and something put deep in my arse(.have to wait atleast 3 months from seeing doctor to getting any kind of referal to the hospitL and they keep sending me for things i have all ready have had like blood tests and lung capacity tests so now have come to the end of my tether and am now looking in to getting the operation in another country,anyone have any info on how much and which type of opperation they do and best place to get it?any help would be greatly helpful as this is impacting my life greatly.

I can't say where to get the operation. In the states it is done in the specialist's office. They stitch a little "knot" in your throat so that nothing can ever come up--- everything goes south from then on. Not sure about burbing but you never throw up again.

Hiatal hernia repairs are done in hospital, and do not make it impossible to vomit (that would be undesirable, since vomiting often serves a necessary function). It will decrease regurgitation due to HH though, and likewise decrease the reflux.

Usually involves a 2-3 day hospital stay if done laparascopically.

As mentioned, surgical repair is seldom needed, especially for a sliding HH and indicated "only if symptoms are severe". OP states symptoms are sever, my concern is that they may not be totally due to his HH, but he obviously believes they are.

Any of the main hospitals in Thailand can do a repair, but laparoscopic procedures are expensive so it may indeed be worth persisting with the government health system back home. By expensive I mean probably in the realm of 150 - 200,000 baht give or take depending on the hospital (and that's of course not including airfare, hotels etc). Saint Louis Hospital is probably the lowest cost private option, could email and ask for an estimate www.saintlouis.or.th

India would be less expensive than Thailand but I cannot advise re hospitals there are the quality of care varies greatly from place to place.

in any case be sure to research the qualifications of the surgeon.

[smilingbuddah]

I have had a Hiatus Hernia for years with extreme heartburn.

I ate buckets of Rolaids till the Doc put me on Pariet which has worked very well for me since going on them.

I'm also told Losec works well too.

Hope you find some relief soon

S.B.

[meatboy]

one thing the op needs to do is write everything he suffers with,what he has eaten,i suffered from the 70's till around 2002 when i was put on zoton lansoprazole in the uk.these are very expensive and when the nhs.cut back on the most expensive tabs.and started dishing out generics i was having none of it and took the nhs to a tribunal so they carried on supplying me with zoton,after a couple of yrs they done it again and there was no way for me this time but to except generics,but they worked so i began to have faith in them.then came the bombshell i had been having some of what the op is experiancing i was told write everything down and go and see a cardioligist who after reading what i had put down came up with exactly what was wrong,leaking valve,blocked arteries.so i suggest the op goes and see who sheryl has recomended a dr.taworn in this forum only if its for peace and mind.

[smokie36]

I had my first taste of acid reflux last week. Breathing fire indeed! Noticed a lump at the back of my throat and it took a couple of weeks to figure out why.

I took a course of Gaviscon for a week and that has settled things down in addition to cutting out my morning coffee completely and cutting back a lot on the beer.

Also eating a meal at 8-9pm I now try to eat no later than 7pm. All of these things have helped.

Bit of a wake up call on lifestyle.

[meatboy]

I had my first taste of acid reflux last week. Breathing fire indeed! Noticed a lump at the back of my throat and it took a couple of weeks to figure out why.

I took a course of Gaviscon for a week and that has settled things down in addition to cutting out my morning coffee completely and cutting back a lot on the beer.

Also eating a meal at 8-9pm I now try to eat no later than 7pm. All of these things have helped.

Bit of a wake up call on lifestyle.

its not a nice thing expecialy when laying in bed and it[acid] releases and comes up to your throat,try and elavate your bed just a couple of house bricks under headboard end,sorry smokie but i cannot recomend gaviscon,so if it does get worse get some omeprazole [miracid] 20mg they should do the trick.i pay 50bht.box of 14tabs.you will find a drink is ok.but watch what you eat and not toooooo big a meal.

[Sheryl]

one thing the op needs to do is write everything he suffers with,what he has eaten,i suffered from the 70's till around 2002 when i was put on zoton lansoprazole in the uk.these are very expensive and when the nhs.cut back on the most expensive tabs.and started dishing out generics i was having none of it and took the nhs to a tribunal so they carried on supplying me with zoton,after a couple of yrs they done it again and there was no way for me this time but to except generics,but they worked so i began to have faith in them.then came the bombshell i had been having some of what the op is experiancing i was told write everything down and go and see a cardioligist who after reading what i had put down came up with exactly what was wrong,leaking valve,blocked arteries.so i suggest the op goes and see who sheryl has recomended a dr.taworn in this forum only if its for peace and mind.

From the sound of it the OP is not in Thailand at present.

But given his complaints of severe shortness of breath I do agree that a cardiac evaluation is indicated. However seems unlikely this has not already been done and cardiac cause excluded?

[jrtmedic]

Agree -It is extremely unlikely that the OP has not undergone a cardiac evaluation given the symptoms he describes and especially as he talks about " lung capacity tests"

The OP tells us very little about his age or medical history making it difficult to offer solid advise via the forum.

The OP is obviously concerned about his condition and should , as I suggested earlier, make an appointment with his Family Doctor (GP) who will provide/facilitate access to appropriate care.

[Tolley]

I had my first taste of acid reflux last week. Breathing fire indeed! Noticed a lump at the back of my throat and it took a couple of weeks to figure out why.

I took a course of Gaviscon for a week and that has settled things down in addition to cutting out my morning coffee completely and cutting back a lot on the beer.

Also eating a meal at 8-9pm I now try to eat no later than 7pm. All of these things have helped.

Bit of a wake up call on lifestyle.

Here are a few suggestions that might be helpful

Avoid cigarette smoke.

*Eliminate caffeine.

*Eliminate alcohol.

*Eat a healthy diet and most of all, do not overeat.

To relieve or eliminate symptoms of acid reflux/Gerd:

*Mix one tablespoon of raw apple cider vinegar in an 8 oz glass of water and sip during meals.

*Take probiotics to keep the beneficial bacteria in your intestines thriving.

*Digestive enzymes will help proper digestion.

Herbs that will help ease the symptoms of acid reflux/GERD are the following:

*Slippery Elm Tea is a very effective remedy. It covers the mucus membranes of the esophagus with a protective coat that relieves inflammation caused by acid. Slippery elm also helps to lower excess acidity by stimulating increased mucus production.

*Calendula Tea soothes inflamed tissue and reduces inflammation.

*Gentian Tea, an age-old digestive aid, prevents heartburn. Simmer one teaspoon of gentian in a cup of water for 30 minutes. Sprinkle just a pinch of ginger and cayenne in the tea. Drink one-half hour before meals.

*Chamomile, known for its anti-inflammatory properties, is a natural remedy for digestive conditions. Drink a cup of chamomile tea up to four times a day, between meals.

*Cinnamon helps calm and soothe the stomach.

An acid reflux wedge pillow will relieve discomfort by elevating the upper body.

I would also add make sure you eat very slowly and chew your food very carefully.

Some of the worst things that you can eat or drink are soft drinks especially coke, beer and chocolate. These are poison for people with your condition. Be careful with wheat and dairy as these may also aggravate your condition. I would definitely cut out bread.

Eat a bowl of oats every morning to line your stomach, bananas, cabbage, apples are all good foods.

If you are going to drink buy some slippery elm capsules and take two or three before you go out drinking and the same before you go to bed. THey help line the stomach.

[jrtmedic]

Interesting! but i dont believe Smokie36 requested "alternative" or indeed any advise

[Tolley]

Interesting! but i dont believe Smokie36 requested "alternative" or indeed any advise

You cant help yourself can you?

Seeing as I have had the same problem thought I would share some ways to alleviate the condition if that is ok with you.

Edited May 25, 2013 by Tolley

[Sheryl]

Caffeine is indeed a common exacerbator of GERD.