reflex /haital hernia

[NOCHNOCH]

have been diagnosed w/ gastritis and duodenitis and have been taking 40 mg of prilosec daily. my main concern is my reflex. i am 21 now and have had this problem since i was 14. i would constantly belch up chunks and liquid about 15x a day. i dont have heartburn dialy but when i do it feels like somone is squezzing my chest with a huge clamp, it is bad when it happens. i recently had a endoscopy which showed i have a sliding haital hernia. it didnt show any type of severe gerd. my surgeon also treated me w/ healadac for h pylori. i tried nexium and protonix when i was younger and modified my daily habits which still didnt improve my symtpoms much. what would be my next step. its burning between my pecks when the liquid seems to marinate in that area.

[gnorb]

Based on your description, your next step might involve surgery. However, you may want to request both a pH test (Bravo 48 hr pH study) and, given that you have not just reflux but regurgitation, an esophageal manometry exam. (More info at http://www.gicare.com/Endoscopy-Center/Esophageal-Manometry.aspx).

That said, your description sort of leaves a few things up in the air. When did the h. pylori occur? Was it proven to be cured? (ie, rerun tests, make sure it's gone.) When did you try the medicines? Are you on any medication now? What efforts are now in place to help with the acid?

For the hiatal hernia, weight loss will be your best bet. Tilting the head of your bed up at least 12 inches will also help some, as will not eating 3+ hours before going to bed. (Don't use pillows to prop up your head: that must makes it worse.) I've had very good luck with both Yoga and acupuncture for treating hiatal hernia. (Dx'd when I was 18 with a hiatal hernia. 10 years later I had an EGD. No hernia.) Finally, breathing exercises and singing lessons will also help out: strengthen the diaphragm and the hernia won't slide up. No slide, no mechanical failure, no heartburn (in theory). Ta da!

For the heartburn, first and foremost you'll need to do a GERD diet, plus make sure you're eating 6 small meals instead of 3 large ones. Thing is, when the hernia slides it can pinch the Vagus nerve, which can effect the emptying rate of your stomach. Lots of food in the stomach will make this sliding more likely.

Next is your food: try to make sure what you're eating is more neutral to alkaline: less processed foods and grains, more fruits, veggies, and lean meats.  This will make heartburn less likely because this type of diet tends to strengthen the LES, which if it isn't all discombobulated because a sliding hernia knocks it out of place, will stop acid from refluxing. Also consider moving towards a more liquid based diet: liquids will stay in your stomach a shorter time, and it will distend less, making it easier to avoid a slide in the hernia.

During the day time, keep gum and hard candies with you. (No mints.) Saliva is an excellent antacid. Drink little bits of water throughout the day, too, to wash the acid down.

What you need to do now isn't easy. To attack this thing you need to employ a multi-tiered approach. If you stick with you'll eventually be able to control your symptoms.

Good luck.