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After Hiatal Hernia Surgery - I Have Pain When Eating

  My name is Leonard Navarro, i am a 21 year old male.
  In August of 1997 I went in to have laproscopic surgery for a
  Hiatal Hernia Repair as I was having severe acid reflux. I am 21
  now and opted for the surgery so I didn't have to have medication
  for the rest of my life. Anyways, Things were reasonably well for
  about 5 months when in January of this year, I started having pain
  whenever I ate food.  In the last month and a half I've lost
  15 pounds and losing more everyday as now I can't really eat anything
  without having the pain. I've been to GI's and the surgeon but no
  one seems to have any idea. I can describe the pain as follows:
  It is a function of how much i eat, not when i eat.
  all solids, milk, juice bring the pain on.
  It is pain that is above my eyes, like a severe headache.
  also pain inside my throat, not a soar throat but inside it
  like you are pulling it or squeezing it. The pain here is not
  nearly as severe as the pain around the eyes.
  I also feel tight in my chest, right between the breasts before
  the end of my ribs. minor pain but again not nearly as much
  as around the eyes.
  If i persist and eat, i'll end up getting sick and wanting to vomit,
  but am unable to because of the surgery that i've had. The pain
  can last from .5 - 8 hours.
  I've been on several druges to see if i was still having problems
  with too much acid. I have had an Endoscopy to see if anything visible
  was wrong down there which was fine. I've done a gastric emptying study
  which was fine and a barium swallow which was also fine. The GI
  that i saw even stretched the throat to see if it was to tight,
  with no positive results.
  Please help. any thoughts would be appreciated.
  Leonard A. Navarro
Dear Leonard,
Your physicians have completed many of the tests necessary to evaluate the cause of your symptoms.  The endoscopy has excluded structural abnormalities of the esophagus and stomach.  The gastric emptying test eliminates gastroparesis as a cause of your problem.  The only possibility not adequately evaluated is esophageal dysmotility.  Normally when you swallow solid food or liquid the esophageal muscles starts a muscle contraction that moves from the top of the esophagus to the bottom.  This rolling contraction (peristalsis) forces the swallowed material towards the stomach.  At the lower esophagus, the sphincter relaxes as the bolus approaches, allowing entry of the swallowed material into the esophagus.  Simultaneous contractions in different parts of the esophagus or absence of contractions will interfere with the smooth movement of the swallowed material down the esophagus.  Similarly, failure of the lower esophageal muscle to  relax at the proper time can also cause pain and discomfort with eating.  
I think that the barium swallow was ordered to assess esophageal motility, but, unfortunately this test is not sensitive enough to pick up the abnormalities of esophageal motor functions.  You need an esophageal motility study to assess 1) peristalsis and 2) relaxation of the lower esophageal sphincter.  
If you want Dr. Zonca of the Division of Gastroenterology at Henry Ford Hospital, one of our experts in the evaluation of esophageal disorders, would be happy to see you. He would review your outside records and arrange for the necessary tests to complete the evaluation of your problem.  You can arrange for an appointment by calling the Henry Ford Physician Referral Line at (313)  876-2393.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
*keywords: hiatal hernia repair, swallowing, chest pain

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