Hiatus Hernia and Reflux

[Andydrew]

I was diagnosed in July (via an endoscopy) with a small, minor hiatus hernia. (Barium swallow did not pick it up.)

My reflux symptoms were chronic/strong for six months prior to diagnosis, with chronic belch contractions and stomach pain. I was told I would have to stay on medication, one of the proton pump inhibitors for the rest of my life.

I did not do well on Aciphex, but did well (2.5 months) on Nexium; the reflux almost disappeared. But now the reflux has come back strong and Nexium doesn't work.

I tried Protonix, which I had taken previously, and it worked for a few days, but no effect now. I tried Protonix (morning) and Zantac at night, nothing helps.

I wake up at night constantly coughing, pressure on my chest. I fear eating. Everything, anything, creates reflux.  The only thing that helps is eating small portions, and not eating at least 4 hours before sleep. I have to sleep practically upright and my back and legs hurt in the morning. I am too young to feel this old!!

I exercise regularly--swim and walk, and it doesn't help the reflux but it keeps me in shape mentally and physically.

Finally, my question:  

If I don't take medication I could develop Barrett's Espohagus and esophageal cancer. If I do take the medication I reduce acid in my stomach, long term, which
can compromise my health and lead to stomach cancer, malnutrition, and other problems from the medication's side effects--vision, GI tract problems, etc.

What options do I have, and do these medications need a period on and a period off to work effectively?

[MTV]

AndyDrew...don't give up.  I am going through much the same as you.  It sounds like we are on a long road of trial and error to see what works and what does not work.  I also feel to young to have all this going on.  30 years old and I have a hiatal hernia, acid reflux, irritable bowl and am also still having pain in my RUQ after having my gallbladder removed.  Aciphex does not work and Nexium, what I am on now, seems to have stopped working.  I too have to practically sleep upright and I am currently trying to avoid lactose and fats from my diet.  I exercise regularly (walking and yoga).  It is so frustrating to feel like you are doing all that can be done and still have it come back on you with a vengence.  I have found tremendous support and info on these boards.  Don't loose hope....I know how hard this is.  If I find something that seems to help, I will pass on the info.  Good Luck!

[Andydrew]

MTV,

Thank you for your reassurances. I hope you feel better soon.

I decided to go off all medications and then slowly reintroduce things so I can montor the changes. I have not had any PPI's for two days and the reflux isn't worse, in fact it's a little better. I am getting strong contractions, like attempts to hiccup, but no hiccup. Lasts for a few minutes then goes away. I also have a burning sensation in my stomach.  Otherwise, I'm not any worse without meds. I'm watching what I eat and when.

Nice speaking with you.  Andy

[Medina]

Not sure if I have hiatal hernia yet, I have not been diagnosed but also have similiar problems...with a unique one to add...was wondering if it ever happened to you... during a reflux attack, the acid seems somehow to get over into my broncial tubes, as I cough and am congested for a day or so afterwards...then clears up.  The sputum is clear and has consistancy of mucous...I am scared that it will damage my bronchial tubes if the acid can actually get there...and if not, what causes the congestion...as the lungs and stomach are two different areas.  Help!!

[Andydrew]

Hi,

Yes, I have something similar.  

I get strong contractions that make me feel as if I am about to hiccup or belch, but it doesn't actually happen. Sometimes  the pressure is so striong though, that I get a little relief if I do belch but I also get a burning spray. Just once or twice can cause a couple of days of chest pain with a wet cough and slight wheeze. I have not had any mucous come up.

I believe the process is that the acid goes from the stomach back up the espophagus where it escapes into the trachea which leads to the lungs. The heart and lungs are connected via blood and next to each other so it can feel like the heart is burning.

Make sure you keep the acid neutralized or reduced with PPIs (Nexium, Protonix, etc) as the acid is very damaging to the esophagus and lungs.

Have you had any tests?

Andy

[smart_squared]

Hi All,
Just came upon all your posts and thought I'd add some information.  Although many people have hiatal hernias (HH)and never know it, when reflux symptoms occur something must be done.  In normal patients, the Lower Esophageal Sphincter (LES) is an area of high pressure between the stomach and esophagus which, among other things, keeps stomach acid from entering the esophagus.  This LES is also usually situated about where the diaphram lays (this divides the abdominal cavity from the chest cavity).  Part of the problem of a HH is that when the diaphram opening gets bigger, thus allowing part of the stomach to balloon up into the chest cavity (ie hernia), it pushes the LES well above the diaphram area and thus the LES loses some of its "strength" and winds up letting more acid through.  Please note, however, that it is absolutely possible to have reflux WITHOUT a HH due to low LES strength, inappropriate opening of the LES, or inability to clear reflux due to uncoordinated esophageal body muscles (everybody refluxes but most clear it immediately with no damage or symptoms). Usually the acid is refluxed up into the lower esophagus but in some patients, the reflux can be refluxed even through the Upper Esophageal Sphincter (UES), the sphincter which separates your throat from your esophagus.  When this happens, reflux material can be microaspirated into the lungs, thus causing a host of pulmonary and ENT problems such as you all have described (cough, nasal drip, tightness in lungs, sore throat, etc.).  Reflux in the throat and lungs is so irritating because not only are the throat/lungs not designed to clear reflux but the mucous lining of these areas is very thin and not designed to protect against reflux like the thick mucous lining of the esophagus is.  Consequently, more damage is done with much smaller amounts of reflux.  The most conservative treatment usually involves lifestyle change.  Medication to either surpress acid in the stomach or strengthen the muscle tone of the LES/Esophageal Body is the next step.  The surgical procedure called a Laproscopic Nissen Fundoplication is also a common option and is often recommended for patients who have reflux occuring above the UES since meds often do not control the reflux.  In the Nissen procedure, the top part of the stomach is wrapped around the LES to give it additional strength to stay shut and any HH's are also fixed to bring the LES back down to the diaphram level.  Most patients can eliminate their meds after a Nissen although a small number of people have problems with the inability to belch or vomit afterwards.  These are usually short lived but can be long term problems (studies have shown that even severe cases only need a "loose" wrap and this will greatly reduce the chance of complications).  To determine if you are a candidate for surgery, you must have an esophageal manometry study done.  They will pass a small catheter with pressure sensors on it through your nose and down through your LES.  While giving you small sips of water, they'll be able to tell if your LES is weak (good candidate), opening at wrong times (good candidate), or your esophageal body is uncoordinated (don't have surgery!).  If you choose to look into the surgical option, I would seek out a center/physician who specializes and is very experienced in this proceedure.  Many physicians order the manometry test for their patients but often are not very adept at interpreting the results and/or the person doing the study is not experienced enought to get a "good study".  Also keep in mind that both gastroenterologists and surgeons order these tests and that most GIs will tend to be biased toward using meds and most surgeons will be biased toward doing surgery (often it's kind of a turf war). Having never had reflux myself, I must say it was a humbling experience when, for 5 months during my pregnancy, I had horrible reflux.  The empathy I gained for patients was incredible and I can honestly say that I don't know how so many people put up with the symptoms for 20, 10 or even 2 years!  Sorry for the long windedness!  Good luck and be an advocate for your health!

[marygold]

I also feel like I'm too young to be going through this. I have severe GERD and I was wondering what the long term effects of taking PPI's were. I have been taking Nexium for about 10 months, and it still seems to work, and my doc says I'll be on them for the rest of my life. I already have complications, such as narrowing of the oesophagus, from him misdiagnosing me for 4 years. I was 16 when I was diagnosed (not by him, btw) and was about 12 when I started complaining of symptoms. I'm now 19 and trying to lead a normal life. Nexium is about the only medication I found that helps control my reflux, but not always. It doesn't work near as well when I'm sick, overly anxious, excited, or upset. Do you know of anything I could do to keep the acid down when Nexium isn't as effective? I have made some lifestyle changes, not many because I never smoked or drank before, and I'm not overweight. I stick to a strict diet, and cook all of my own food so I know it's okay for me to eat. Sometimes I just get so frustrated and I know it's not going to get better, and that just makes me more frustrated. How can I not get so irritated at my body all the time? Any ideas?