Hiatal Hernia problems

[nursedeb]

Hi,
I have been having spasms midepigastric and right below my sternum to the left side. Sometimes it feels as if the pain is under my ribs. I occasionally feel the pain go to my back on the left side, but not very often. When I have an empty stomach 99% of the time I have no symptoms. But if I drink anything or eat anything usually within minutes I will get the spasms. They come in waves and only last a few seconds at a time. The spasms get way worse if I lay down after eating. They also seeem to be worse if I eat too quickly or eat a big meal. I also notice that sometimes I get the spasms if I get up quickly, bend over, cough, laugh or cry.

I was diagnosed with a hiatal hernia 2 years ago. I was just scoped again last weeks and my doc said the hernia is less than 1 cm. I take Nexium 40mg daily for reflux and it seems to work pretty good. I do get the occasional heartburn though. I also used to drink a lot of alcohol. I quit 2 and 1/2 months ago, the same time that I started feeling the pain. I was worried that it could be related to the drinking. About 10 days after my first episode of pain I had blood work done. My lipase was 68, normal range 0-57. Amylase normal. All other labs normal. I had my blood work repeated 3 weeks later and everything was normal. I have had an abdominal ultrasound, abdominal CAT scan, HIDA scan, EGD and MRCP, all perfectly normal. My doctor says that he just can't imagine that all my symptoms could be coming from my hiatal hernia. But Im wondering if it's possible, because it seems like anything that increases pressure (coughing, laughing, crying, bending over) causes the spasm. I have no nauses, vomiting or diarrhea. No other symptoms to speak of, except for the occasion pain radiating to back on the upper left side. Oh and I noticed that within the last week my symptoms have changed a little. I now sometimes have pain in my chest, especially after eating a big meal.

My doctor put me on Bentyl initally, which seemed to help a little but it made me so drowsy I had to stop taking it. He just started me on Pamine forte. I was wondering if the symptoms I am having could be Sphincter of Oddi Dysfunction. I do still have my gallbladder. Also, I was initally very worried about pancreatitis. But I don't have abdominal pain, I only have spasms. The only pain that I have is in my chest after I eat. I am concerned about the one time elevated lipase, and for the record I havent touched a drop of alcohol since this whole thing started.

My GI doctor wants me to contine taking the Pamine and see him in one month. If I am still having symptoms he is going to do a small bowel series and a gastric emptying study.

My questions:
1. Does this sound like a hiatal hernia?
2. Could this be pancreas related and what other tests should I get to find out.
3. If this is a hiatal hernia, I am condsidering having it surgically fixed. What is the success rate for that?
Thanks
Any other thoughts or advice would be great.

[Kevin Pho, MD]

To answer your questions:
1) It is possible that the symptoms may be related to the hiatal hernia.  You may want to consider any form of esophageal motility disorder as well - which can cause esophageal spasm. This can be evaluated during a 24-hr pH test with an esophageal motility study.  

2) Yes, with an elevated lipase, it is possible that the symptoms can be pancreas related.  Imaging with a plain film or CT scan can be of some value.  If chronic pancreatitis is found, you may want to consider treatment with pancreatic enzyme supplementation.

3) If the symptoms are due to the hiatal hernia, the success rate would depend on what type and the severity of the hernia.  I cannot comment on exact numbers without being personally involved in your case.

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.
Medical Weblog:
kevinmd_b

[surgeon]

Hiatal hernias are more common than are symptoms: a I cm hernia might not be significant at all. When they do cause symptoms, it's generally in terms of reflux, which can cause heartburn, but not the waves of pain you describe. If you were having reflux to the degree that it caused severe pain, it's highly likely the EGD would have revealed inflammation of the esophagus. Transient elevation of lipase is consistent with pancreatitis. That, as you seem to know, can be related to drinking, gallstones, or both. Stopping drinking may not stop bouts of alcohol-related pancreatitis. The success rate of surgical correction of reflux associated with hiatal hernia is very high; but in your case it's not clear to me that surgery is indicated, because it doesn't seem that the diagnosis is yet clear.

[anil1111]

surgery for Hiatal Hernia.

new to these threads. very good and interesting reading.

I have one and causing accute problems.

[1] what is the size of hernia for which surgery is recommended?

[2] Is laproscopy surgery better?

[3] How sucessfull surgery or laproscopy has been?

[4] How do I find a experience surgeon [ what determines his experience with such surgeries?] in NJ 07960 area?

thanks for your help

anil

[yoshi]

you may have to post a new thread for your questions,docs usually do not review past threads if they have responded already