Do I Have a Hiatal Hernia

  For the last 2 years I've experienced severe bouts with heartburn that last up to 6 days at a time. I usually get these about once every 3 or 4 months or so.  During these bouts I am totally debilitated, and even ended up in the ER room twice with horrible chest pain.  Heart problems were ruled out though and only mild esphogeal irritation showed up on my endoscopy. This past month has been the worst yet, as I've been in pain every day. I've been put on Prilosec which seems to be helping a little, but not enough. Could I have a hiatal hernia? I have noticed that doing sit-ups seems to bring on the heartburn sometimes, as does asprin. I also do alot of heavy lifting in my job, and my Mom has a hiatal hernia.  My GI Doctor doesn't seem to think that's the problem. I'm thinking of getting a second opinion.

  
      
Dear Vivian,
In most cases a significant hiatal hernia can be detected on endoscopy. A barium esophagram (x-ray) can also detect a hiatal hernia. Hiatal hernias, in and of themselves, are not usually  responsible for symptoms. It is the esophagitis or inflammation noted on endoscopy that confirms the diagnosis of gastroesophageal reflux disease with reflux esophagitis. The inflammation is a consequence of continued damage to lower esophagus from acid. Omeperazole (Prilosec) is a strong inhibitor of acid secretion, but it may sometimes take a while for symptoms to improve or it may require a higher dose for you to feel better. In general, it may take up to 12 weeks for healing of esophagitis to be complete. You might also benefit from adhering to strict anti-reflux measures and discontinuing the aspirin. Aspirin and other non-steroidal anti-inflammatory drugs are known to irritate the gastrointestinal tract. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568 our Referring Physicians' Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: hiatal hernia, gastroesophageal reflux disease, esophagitis, omeperazole