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Hiatus Hernia severe pain
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Hiatus Hernia severe pain

  I have been suffering with Hiatus Hernia for 2 years with a weight loss of 47 pounds. I take prevacid and verapamil for spasm and I still get severe pain under the right breastbone and into my right shoulder.l  have been hospitalized in emergency twice for inability to breathe and severe pain.  I keep to a very strict diet.  what am i doing wrong?  is there anything i should not be eating?  my doctor wants to do a bile duct test to see if I have possible problems in that area.  He says it is risky in develping pancreatitis.  So, i have resisted.  I am going for second opinion on my condition this week.  Is ther anything you can tell me that might help me out h ere?  are there any specialists in NY that deal exclusively with hernia conditions>  what do you think>   I can't afford to lose any more weight.
  Thanks for anything you can help with.  Roseanne
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Dear Roseanne,
I read your letter with great interest and admit to being perplexed by your symptoms.  I assume that the weight loss is involuntary.  It is unusual for a hiatus hernia to produce such profound weight loss.  If you are unable to eat because of food sticking in your esophagus or pain with swallowing, then you should have a more advanced evaluation of your esophagus including a motility study, 24 hour pH probe and an endoscopy.
Your letter suggests that your physicians are also having difficulties identifying the cause of your pain and weight loss.  You do not provide your age.  If you have risk factors for heart disease (elevated cholesterol, high blood pressure, diabetes mellitus, family history) you should have an appropriate cardiac evaluation to exclude cardiac ischemia as the cause of your pains and shortness of breath.  It is also necessary, however, to exclude gastrointestinal etiologies.  Your physician is concerned that your bile duct and/or pancreas is the cause of your pains and wants to do the ERCP to visualize these structures.  Indirect information regarding these structures can be obtained by ultrasound or CT scan, but the information is not as detailed as with an ERCP.  
One group of causes of weight loss not mentioned in your letter is intestinal disease.  There are a number of possible causes including small intestinal mucosa disease, pancreatic insufficiency and inflammatory bowel disease.
Therapy can only be successful once the cause of your symptoms is known.  I do not think that dietary manipulations will improve your symptoms. I strongly encourage you to continue the investigations with your physicians.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by a physician. If you wish to be seen at our institution, henry ford Hospital, please call our PHYSICIAN REFERRAL LINE at(313) 876-2393 and request consultation with Dr. Fogel, one of our experts in the investigation of weight loss.  He can determine the best approach to your investigation after completing a history and physical examination.
*keywords: hiatus hernia, esophageal spasm, dysmotility, weight loss, malabsorption

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