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Gastroenterology (Expert Forum)
Hiatus Hernia Mallory Weiss Tear
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Hiatus Hernia Mallory Weiss Tear
by robjames, Jan 25, 2005 12:00AM
My father now aged 77 was diagnosed in 1996 with “...a moderately large incompletely reducible sliding hiatus hernia with free gastro-oesphageal reflux and signs of long standing reflux oesphagitis with little focus stenosis of the distal oesphagus.” This condition(s) was effectively managed until 2004 by taking one 20mg tab of omeprazole magnesium daily.
In 2004, my father was hospitalised many times with haematemesis, which was diagnosed as bleeding from either a recurrent or new mallory weiss tear. Hospital management of this condition was either achieved by intravenous infusions of omeprazole and maxalon and/or endoscopy injection of sites. My father was told to take two 20mg tabs of omeprazole magnesium daily in future (this was later changed to one 40mg tab of pantoprazole).
While in hospital undergoing tests in March, an adenocarcinoma of the lung was diagnosed. A right upper lobectomy was successfully done in July with good prognosis. However, this procedure left my father with shortness of breath (on walking/exertion), chest pain (for which he takes gapapaten tab three times a day) and feeling rather weak. In October, he had an infected cyst of the lower pole of right kidney aspirated (klebsiella pneumoniae). He was treated with antibiotics for aspiration pneumonia a couple of times in 2004. He has had deep vein thrombosis and suffers from hypertension.
In December 2004, he was admitted to hospital again with haematemesis and bleeding from mallory weiss tear. Medical imaging and endoscopy identified “...hiatus hernia with a para-oesphageal component which is incarcerated and associated with obstruction to onwards passage of contrast at the oespageal hiatus”. While in hospital a surgical team was consulted re: laparoscopic repair of hiatus hernia. While in hospital the obstruction lessened and a decision was taken to hold off of doing anything surgically to the hiatus hernia for a few months.
My father has since become somewhat paranoid that his hernia is going to twist/strangulate and he will die...to the extent that he says he now has difficulty swallowing food. I am understandably concerned about my father’s health and ability to withstand what sounds like another major operation. How critical is my fathers condition(s) with regards to needing surgery. Is there a chance that the hernia can become strangulated? Would an operation solve all his gastric problems (ie. GORD and bleeding from mallory weiss tears)? Is there anything else my father can do to manage his condition(s)? Is he on the right medications? He currently takes pantoprazole 40mg, gabapentin 100mg, enalpril 10mg, ferrous sulphate 270mg and folic acid. When feeling sick he takes ondansetron 4mg. Before bed he takes a gabapentin tab, 2 tabs of pandeine forte or panadol and 1 temaze tab.
I look forward to your response.
In 2004, my father was hospitalised many times with haematemesis, which was diagnosed as bleeding from either a recurrent or new mallory weiss tear. Hospital management of this condition was either achieved by intravenous infusions of omeprazole and maxalon and/or endoscopy injection of sites. My father was told to take two 20mg tabs of omeprazole magnesium daily in future (this was later changed to one 40mg tab of pantoprazole).
While in hospital undergoing tests in March, an adenocarcinoma of the lung was diagnosed. A right upper lobectomy was successfully done in July with good prognosis. However, this procedure left my father with shortness of breath (on walking/exertion), chest pain (for which he takes gapapaten tab three times a day) and feeling rather weak. In October, he had an infected cyst of the lower pole of right kidney aspirated (klebsiella pneumoniae). He was treated with antibiotics for aspiration pneumonia a couple of times in 2004. He has had deep vein thrombosis and suffers from hypertension.
In December 2004, he was admitted to hospital again with haematemesis and bleeding from mallory weiss tear. Medical imaging and endoscopy identified “...hiatus hernia with a para-oesphageal component which is incarcerated and associated with obstruction to onwards passage of contrast at the oespageal hiatus”. While in hospital a surgical team was consulted re: laparoscopic repair of hiatus hernia. While in hospital the obstruction lessened and a decision was taken to hold off of doing anything surgically to the hiatus hernia for a few months.
My father has since become somewhat paranoid that his hernia is going to twist/strangulate and he will die...to the extent that he says he now has difficulty swallowing food. I am understandably concerned about my father’s health and ability to withstand what sounds like another major operation. How critical is my fathers condition(s) with regards to needing surgery. Is there a chance that the hernia can become strangulated? Would an operation solve all his gastric problems (ie. GORD and bleeding from mallory weiss tears)? Is there anything else my father can do to manage his condition(s)? Is he on the right medications? He currently takes pantoprazole 40mg, gabapentin 100mg, enalpril 10mg, ferrous sulphate 270mg and folic acid. When feeling sick he takes ondansetron 4mg. Before bed he takes a gabapentin tab, 2 tabs of pandeine forte or panadol and 1 temaze tab.
I look forward to your response.
Doctor's Answer
by Kevin Pho, MD, Jan 26, 2005 12:00AM
, Jan 26, 2005 12:00AM
Tough to make a judgement as to what will happen without examining the records nor the patient. There is always a chance that the hernia can become strangulated, especially since it has been incarcerated in the past. If that is the case, then an operation would be necessary for repair - but there are no guarantees that it would stop recurrance.
It seems that he is on an optimal medical regimen - the pantoprazole (Protonix in the US) can help with acid suppression which can improve the symptoms. However, if surgery is needed, there will be no medication that can act as a substitute.
Regarding the Mallory-Weiss tear, there can be various non-surgical techniques that can be used to control the bleeding - including endoscopic hemostasis, balloon tamponade, or embolization. If these measures fail, surgery can then be considered.
These options can be discussed with your personal physician.
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
It seems that he is on an optimal medical regimen - the pantoprazole (Protonix in the US) can help with acid suppression which can improve the symptoms. However, if surgery is needed, there will be no medication that can act as a substitute.
Regarding the Mallory-Weiss tear, there can be various non-surgical techniques that can be used to control the bleeding - including endoscopic hemostasis, balloon tamponade, or embolization. If these measures fail, surgery can then be considered.
These options can be discussed with your personal physician.
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
