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Gastroenterology (Expert Forum)
Chest/upper abdominal discomfort history of hiatal hernia
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Chest/upper abdominal discomfort history of hiatal hernia
by njben, May 14, 2007 12:00AM
Hello,
I have been diagnosed with a hiatal hernia, GERD, gastritis, and esophagitis. I am on Nexium 40mg qd. I was diagnosed with GERD a couple of years ago and the hernia about 2 months ago when I had an EGD and switched to Nexium. I am male, 32-years old, overweight, and a smoker. As of 5 years ago my cholesterol was on the high end of WNL. I also have asymptomatic (or being that its congenital as far as I know asymptomatic) MVP.
For the past week I have been having symptoms consistent with what has been attributed to the hiatal hernia/gastritis in the past (fullness, bloated, epigastric pain and tenderness, difficulty taking very deep breaths, and diffuse what feels like musculoskeletal pain over the rips). However, during this time a new troubling symptom has arose that being a flutter feeling that lasts about a second or 2 in my epigastric and just above that area over the sternum but towards the bottom end of the sternum. It feels like something inside is slightly spasming and causes no pain but it is a little concerning. There are no lingering effects after it ends.
I have been taking a swig of Pepto before meals and that has gone a long way to alleviating the pain but the fullness, bloating, and fluttering still remain. Activity has no effect on symptoms although eating does.
I guess the question I have is regarding the fluttering. The fulness etc is somewhat worse that it was in the past but the feeling is consistent with the past but the fluttering is new.
Thanks for any help you can provide.
Ben Sukovich
I have been diagnosed with a hiatal hernia, GERD, gastritis, and esophagitis. I am on Nexium 40mg qd. I was diagnosed with GERD a couple of years ago and the hernia about 2 months ago when I had an EGD and switched to Nexium. I am male, 32-years old, overweight, and a smoker. As of 5 years ago my cholesterol was on the high end of WNL. I also have asymptomatic (or being that its congenital as far as I know asymptomatic) MVP.
For the past week I have been having symptoms consistent with what has been attributed to the hiatal hernia/gastritis in the past (fullness, bloated, epigastric pain and tenderness, difficulty taking very deep breaths, and diffuse what feels like musculoskeletal pain over the rips). However, during this time a new troubling symptom has arose that being a flutter feeling that lasts about a second or 2 in my epigastric and just above that area over the sternum but towards the bottom end of the sternum. It feels like something inside is slightly spasming and causes no pain but it is a little concerning. There are no lingering effects after it ends.
I have been taking a swig of Pepto before meals and that has gone a long way to alleviating the pain but the fullness, bloating, and fluttering still remain. Activity has no effect on symptoms although eating does.
I guess the question I have is regarding the fluttering. The fulness etc is somewhat worse that it was in the past but the feeling is consistent with the past but the fluttering is new.
Thanks for any help you can provide.
Ben Sukovich
Doctor's Answer
by Kevin Pho, MD, May 15, 2007 12:00AM
, May 15, 2007 12:00AM
An upper endoscopy is a comprehensive test that can help evaluate for upper GI causes, such as a worsening hiatal hernia. You can also consider a 24-hr pH study to quantify the severity of GERD, and esophageal motility studies to look for possible spasm.
If the GERD continues to be present despite maximal PPI therapy, or if the hiatal hernia is worsening, a surgical opinion can be sought for a more definitive treatment.
These options can be discussed with your gastroenterologist.
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.
Kevin, M.D.
kevinmd_
If the GERD continues to be present despite maximal PPI therapy, or if the hiatal hernia is worsening, a surgical opinion can be sought for a more definitive treatment.
These options can be discussed with your gastroenterologist.
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.
Kevin, M.D.
kevinmd_
If you have had the fullness/bloating feeling in your abdomen after eating for a long time, or continue to have it, you might (possibly) have a condition called gastroparesis, especially if you don't have to eat a whole lot in order to get that bloated feelign after meals. From my reading, usually hiatal hernias don't cause symptoms unless they are large (don't know whether yours was or not). I also had chronic reflux, stomach and chest pain (espcially epigastric burning) and a feeling of significant pressure and bloating after eating, especially if I overate (almost as if my stomach was shoved up into my chest-sometimes making it hard to breathe), but basically all day long even when not having eaten for hours. I also had endoscopy and thought they were going to find a big hiatal hernia (I only had a small one-pretty common), but instead, in addition to the gastrititis/esophagitis, there was still food in my stomach after more than 17 hours of not eating, and later I was dxd w/ severe gastroparesis on gastric emptying scan). It is a condition where the stomach doesn't empty food as quickly as it should (basially the food just sits there for hours). There is treatment for it-drugs (Reglan, domperidone, etc.) that help to move the food through more quickly, a low-fat/low-fiber diet (especially avoid certain foods that are not easy to digest, eating small meals often instead of big ones (don't overeat), losing weight if overweight, etc. Anyway, the definitive test for it is the gastric emptying scan-EGD doesn't usually pick it up unless it is severe-- as one can't eat for many hours before undergoing anesthesia.
I am a 75 year old asian female; from the beginning of January of this year, I started to feel a bloated or feeling of fullness in my stomach after eating just a small portion of food and only to find in just a short period of time later (30-60 minutes) that I was hungry again but with the same consequences again and again; it is very frustrating; some days are better but some days it becomes worse. I usually have to lay down in bed or on the sofa to just relieve the bloatness in my stomach.
I contacted my gastro. physician; she proceeded with an endoscopy and a ct scan of my stomach; my physician found that I only had a mild case of gastritis. My physician ruled out any type of ulcers, heartburn or cancer. My physician instructed me to take 20mg of achiphex on a daily basis. It is now the middle of May and I have the same symtoms as before. My local pharmacist has recommended a simple over the counter gas-x medication to try. Do you think this will help or be effective to eliminate the bloated feeling and feeling of fullness or is this something more severe?
A week ago on my own, I came across an article that matched my symptoms and proceeded to schedule an appointment with my gasto. physician. We have scheduled a gastric emptying scan this coming Monday to determine if I have gastroparesis. My gastro. physician commented even if I have gastroparesis there are several medications for ex.- Reglan; this has recently been banned because of the side effects it presents. The article did mention how diabetes could be related to gastroparesis; I am a diabetic.
There must be a way to determine what is causing my symptons and I would assume there must be some type of treatment or medication to stop or relieve my symptoms or illness. Should I look into scheduling an appointment with an Endocrinologist since I am diabetic and have a thyroid problem also.
Your thoughts and opinions are greatly appreciated,
Hoai Thanh
I don't think the forum doctor responds to any postings unless you pay to post an original question.
It seems like you are on the right track for getting an answer for your problem. Also, you said you felt better after lying down. I'm not sure why that is, but I do know that if you do have gastroparesis it is not recommended that one lie down after eating, as this slows down the emptying of the food from the stomach. If anything, it is recommended to exercise/walk after a meal. Also, if you have a problem with acid reflux it is not advisable to lie down after eating, as this promotes the reflux.
If you feel full/bloated and your stomach is distended after eating (especially after eating a small or normal-sized meal, then you might have gastroparesis. The gastric emptying scan should tell one way or another. Sometimes the results are equivocal if the GP is very mild, and the test needs to be repeated, but otherwise the scan should pick it up if you have it. If you have started to read on GP then you probably already know it is very common in diabetes, especially type 1 (but sometimes type 2 as well)--just look at all the articles on diabetic gastroparesis on the internet. It also can be seen with hypothyroidism (and you mentioned you had thyroid disease). But sometimes they just don't know the cause of it.
As far as the drug Reglan, I am not aware that it has been taken off the market. The drug Zelnorm, which is sometimes used for gastroparesis (I was on it for that) was recently pulled from the market. But there are other drugs--domperidone (can be gotten from Canada and abroad), erythromycin, and perhaps others lesser used ones that I can't remember at this time. I take domperidone and it helps me some, I think. The biggest thing that helps with my symptoms, though, are controlling my eating-not overeating and not eating late (I try not to eat fewer than 4-5 hours before bedtime or I invariably have bad reflux during night), and it is also recommended to eat low-fat and low fiber (easier for stomach to digest). But of course low-fiber isn't a healthy diet