I have a hiatal hernia confirmed by Barium swallow. ( i have it for 3 years). Due to severe acid reflux I am on Lansoprazole 30 mg twice a day for the last 3 years. Now I have developed severe tightness in the chest area ( I am 33 years and a male and have no cardiac problem). The doctor feels that the esophagus may have a mechanical restriction due to scarring. (To be confirmed by endoscopy). This tightness sometimes is very painful resulting in taking Demoral for relief. Is there a permanent cure? Will surgery guarantee that the hiatal hernia is cured? Or is surgery not a permanent cure? I do not take acidic food and also avoid caffeine. I also take Mosapride tablets. Please advise the best course of action to get cured.
You have a hiatal hernia that is not helped by lansoprazole. You have chest tightness in the area. First, ensure that the chest pain is not cardiac related (unlikely as you are still young - but you may want to consider an exercise stress test to be sure).
An endoscopy is a good idea to ensure that there isn't anything else causing your symptoms.
In medicine, there are no guarantees. If you are still having symptoms and it is due to the hiatal hernia, then surgery would be the next consideration. In general, surgery has excellent outcomes and is dependent on the type of hernia and the experience of the surgeon. It is possible that surgery would be a permanent cure, but this is dependent on the patient.
My immediate recommendation would be to obtain a surgical opinion.
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.
Im not sure I understand what you mean by a "mechanical restriction caused by scarring" but Im thinking maybe you are talking about a stricture which occurs when scar tissue has built up on the lining of the esophagus...It causes a narrowing of the esophagus and the symptoms, for me anyway, are.... painful swallowing, food getting stuck, and sometimes choking. The Dr. can easily dilate them during EGD and hopefully that will take care of it.It doesnt always stay open and may require that it be dilated many times...Im having mine done approx. every 6 weeks right now,it is not fun, but it is certainly better than the pain caused from trying to swallow when you cant and the fear of choking to death....Also, when they get bad it interfers greatly with your social life....I find I make up excuses to avoid going out to eat with people (including my fiance)I have even cancelled business meetings because of it when mine gets bad....There is a big fear of having that happen in a restaurant and well, people just dont understand this stuff..... There is much info on the web about the lap. fundoplication surgery and alot of people have very good results with it, most(that I have spoken with) don't even require PPIs afterwards...However, I think there is some concern about how long the surgery stays effective before it would need to be redone.....Ive heard every thing from 4-10 yrs. so.... who knows.....Hope this helps until Dr Kevin gets back and gives you better answers.....Tessa
You sound like a person who should seriously consider surgery. As with any surgery, results can't be guaranteed. However, if done by an experienced surgeon, the risk is extremely low, the recovery is rapid, and the results are generally excellent. Meaning relief of symptoms with no need for medication. How long-lasting is also unpredictable; but typically it will be for a very long time, even permanent. Again, it depends somewhat on the experience of the surgeon. And the techniques have been improved significantly in recent years with new surgical instruments. Early in the era of laparascopic repair, a less-than complete operation was often done, because it was hard to do the whole thing. Now, the procedure can be done in the ideal way. It may help reduce the recurrance rate further if the surgeon uses what are called "pledgets" to bolster the sutures to keep them from pulling through.
Dear Doctor Pho,
I have always suspected I may have a hiatal hernia. The symptoms are that food if not chewed properly seems to get "stuck" in my chest. I can usually alleviate the symptoms by swallowing water but sometimes I am forced to regurgitate the food matter. I was camping last week and a piece of steak would not go down. Not having any water to drink I foolishly took two or three large chugs off a beer I was drinking. At this point I was completely asphyxiated. I could not inhale or exhale. It was like I was choking but not in my throat. My entire esophogus felt like it had vapor lock from the food and the foaming beer. I thought I was going to die and most likely would have if my friend didn't properly employ the Heimlich manuever and save my life. Are you aware of this happenning to anyone else?
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