Tough to make a judgement as to what will happen without examining the records nor the patient. There is always a chance that the hernia can become strangulated, especially since it has been incarcerated in the past. If that is the case, then an operation would be necessary for repair - but there are no guarantees that it would stop recurrance.
It seems that he is on an optimal medical regimen - the pantoprazole (Protonix in the US) can help with acid suppression which can improve the symptoms. However, if surgery is needed, there will be no medication that can act as a substitute.
Regarding the Mallory-Weiss tear, there can be various non-surgical techniques that can be used to control the bleeding - including endoscopic hemostasis, balloon tamponade, or embolization. If these measures fail, surgery can then be considered.
These options can be discussed with your personal physician.
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.
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