Re: Hiatal Hernia

Posted By HFHSM.D.-rf on February 28, 1998 at 12:45:33:

In Reply to: Hiatal Hernia posted by John on February 12, 1998 at 04:16:10:







: For the last 6 months, I have been dealing with what to me feels like bloating
and belching and stomach pain.  I first was being treated for an Ulcer due to
the positive test for H. Pylori.  Since the treatment didnt cure the symptoms,
A month ago I was referred to a specialist who performed an EGD, and diagnosed me with
a sliding Hiatal hernia, mild to moderate esophagitis, and gastritis. I've been
on Prevacid for the last month (I heard it was similar to Prilosec, which I was
taking for the ulcer for approx. 3 months.) I was a smoker, and quit because I
heard this could be causing the problem.  After 1 month of treatment on Prevacid, I have
no improvement.  Is this normal?  How long does it normaly take for a Hiatal Hernia
to heal?  Everyone's surprised that I am having this problem at age 24.  Any Input
would be greatly appreciated!  Thank you for your time.
John




Dear John,
Bloating, belching and stomach pains are common problems in the population.  It is possible that your abdominal pain is related to the gas distention, particularly if the symptoms are concurrent. Excessive abdominal gas is usually the result of swallowed air.  People who talk when they eat or who drink and eat will frequently swallow air.  Consequently, they will complain of bloating, cramps after eating or excessive passage of gas either by mouth or rectum.  Sometimes, the cause for the gas problems is a change in diet: drinking more soda, increased milk intake, or eating more salads.  As these foods are digested gas can result.  Finally, if you started to take more fiber in your diet, you may develop a problem with gas.  
From your letter, it is not evident to me that you have had an ulcer.  We know that people with H. pylori infection have an increased incidence of ulcer disease, but not everyone with H. pylori infection will develop an ulcer.  There are a number of different treatment regimens available to eradicate the infection but they require antibiotics in addition to the inhibition of acid secretion.  Unless you have received a combination regimen, it is unlikely that you have eradicated your infection.  ( Parenthetically, the NIH consensus conference did not recommend treating everyone with H. p. infection.)
A hiatal hernia is a condition in which a portion of the stomach can move into the chest.  This is a permanent abnormality that is very common in people as they age.  It is not a disease and is usually not a cause of symptoms, although it is associated with esophageal reflux.  Hiatal hernias do not heal.
I believe that you are asking how long does it take until your esophagitis heals.  Usually, medications such as Prevacid and Prilosec will improve reflux symptoms  within a few weeks.  In addition to medications there are a number of lifestyle modifications that you should make:
1) eat three meals per day; avoid snacks.
2) Avoid foods that are associated with increased reflux.  For example, fatty foods, chocolate peppermint are associated with an increased frequency of heartburn symptoms.
3) Avoid alcohol and smoking.  Limit the number of cups of coffee and tea that you drink daily.
4) Do not lie down for several hours after you eat.  Consider sleeping with your head elevated to an angle of approx 45o.   Doing this will reduce the amount of fluid that can reflux into your esophagus when you sleep.  
5)  Chew gum during the day.  The increased salivation will neutralize acid that refluxes into the esophagus during the day.
If these conservative measures do not improve your symptoms of stomach pain and/ or you develop symptoms of weight loss, vomiting you should be reevaluated by your physician.
Best of luck.
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 are in the Detroit area or would like to be seen at our institution, please call 1-800-653-6568, our Referring Physicians Office and make an appointment to be seen with Dr. Ronald Fogel of the Division of Gastroenterology, one of our experts in the treatment  of diseases of the esophagus and stomach.
HFHSM.D.-rf
keywords: esophagitis, reflux, H. pylori, gas
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