Digestive Disorders / Gastroenterology Expert Forum
Is 'conservative' approach best?
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Is 'conservative' approach best?

My mom was diagnose with a hiatal hernia over 20 years ago.  She dealt with it primarily by changing her diet and avoiding foods that irritated her.  She is 59 years old and very active, works out everyday, eats healthy, and is not overweight (nor has she lost any weight lately).  Within the past few weeks, she has had difficulty swallowing.  It gets worse if she has spicy foods (such as last night she could eat french fries without problem, but not highly peppered fish).  She also has an intermittent sore throat, coughing and occasional hoarseness.  She went to see a gastrologist who did not do any physical examination of her other than feeling her stomach for tumors.  He told her he would try the "conservative approach" since she appears healthy and prescribed protonix with the guide that if it did not help her in 4 weeks and then they would check for tumors and more serious conditions.  She has been on the protonix for 3 days and says it helps a bit, but that now she feels like she has the flu and is slightly nauseous after taking it.  I am a born worrier, so I am wondering whether it would be better for her to have the tests now rather than wait a month?  Thank you.
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Difficulty swallowing - especially in those over the age of 50 - necessitates further evaluation.  Simply feeling the stomach is not sensitive enough to detect any cancers.  

An upper endoscopy would be the test of choice.  One can consider a barium swallow/upper GI first, but the endoscopy really should be pursued.

You can discuss these tests with your personal physician, or consider another GI 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.

Kevin, M.D.
1 Comment
Hi there,

A few questions:

1. Does she use complete/ partial denture implants?
2. Does she have apthous (mouth) ulceration?
3. When was the last time she was scanned to see the extent of hernia & approx how much of her stomach lies in the thoracic cavity?


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