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Old 11-19-2011, 11:13 PM   #1
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Sliding hiatus hernia?

A sliding hiatus hernia can slide back and forth, so symptoms can come and go.

Before an endoscopy, the patient is required to fast for 4 hours.

Is it possible that after fasting, the hernia can slide back into the appropriate position, causing it to be unnoticed during the endoscopy?

In other words, can eating an amount of food cause the protrusion itself?

 
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Old 11-20-2011, 08:08 AM   #2
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Re: Sliding hiatus hernia?

The sliding happens with every swallow, apparently.

My surgeon says that sometimes a small HH can be missed on endoscopy. I've had 2 diagnostic endoscopies, and one of them claimed I had HH and the other said I didn't!

Next month, when I have my surgery, we'll find out for sure.

 
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Old 11-20-2011, 11:55 AM   #3
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Re: Sliding hiatus hernia?

crap, that isn't good. Do you think that a barium swallow would be better at finding a HH than a endoscopy?

 
Old 11-21-2011, 08:02 AM   #4
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Re: Sliding hiatus hernia?

Quote:
Originally Posted by janewhite1 View Post
The sliding happens with every swallow, apparently.

My surgeon says that sometimes a small HH can be missed on endoscopy. I've had 2 diagnostic endoscopies, and one of them claimed I had HH and the other said I didn't!

Next month, when I have my surgery, we'll find out for sure.
I also have a sliding HH and according to the endoscopy report it seems to be quite large.

Strange though how a previous endoscopy did not show one. If it had been a small one I could possibly understand not being seen before but a very large one?

At this point I can't trust any DR.

 
Old 11-21-2011, 08:09 AM   #5
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Re: Sliding hiatus hernia?

In a way, it doesn't matter whether you have HH or not. Many people have one that is completely asymptomatic.

What matters is whether you have reflux, and how bad it is. Mild heartburn should be managed with diet, lifestyle changes and occasional antacids. More severe heartburn may require prescription meds, and if that isn't adequate, you may consider surgery. Whether my reflux is caused by HH or just by a weak valve, the surgery should help.

 
Old 11-21-2011, 11:05 AM   #6
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Re: Sliding hiatus hernia?

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Originally Posted by janewhite1 View Post
In a way, it doesn't matter whether you have HH or not. Many people have one that is completely asymptomatic.

What matters is whether you have reflux, and how bad it is. Mild heartburn should be managed with diet, lifestyle changes and occasional antacids. More severe heartburn may require prescription meds, and if that isn't adequate, you may consider surgery. Whether my reflux is caused by HH or just by a weak valve, the surgery should help.
I think I have LPR in particular because I don't experience any heartburn. However, I have a chronic postnasal drip which is definitely exacerbated after I eat. I got tested for allergies and food intolerance but everything returned normal.

One thing I did not get diagnosed for is infection. I was never given an X-Ray, CT, or anything like that. I did take antibiotics, but they didn't help. And it is possible that if I had/have an infection, it might have rebounded.

As far as I know, my diet is OK. I don't drink alcohol or coffee at all -- no soda. The only thing I drink is water. I do my best not to consume milk products because I believe I am lactose intolerant. No chocolate, no sweets or any junk food of the like.

I admit I could definitely exercise more. Ideally, I would workout 3 times a week, but I have set that aside until I stop feeling like crap. However, I do heavy lifting at work every once in a while and I used to put intense pressure on my abdomen in the past when I did exercise more frequently. That alone is enough reason to believe I could have a hiatal hernia.

I refuse to take any proton pump inhibitors. It would be idiotic to even take one before at least getting a barium swallow or an endoscopy because the cause of my symptoms (or anyone else's) might simply be due to a weak LES caused by a hernia or what have you. PPIs are just going to make you worse - especially in the long run. The problem mostly likely isn't the quantity of digestive acid, but that it is able to get past the LES or reflux.

In an hour from now, I am going to see my doctor again. I hope that for my sake he schedules me for a barium swallow or an endoscopy, because I have a bad feeling he is just going to prescribe me a PPI and show me the door. If that is the case, I will probably want to make another appointment with a different doctor (a GI) just so I can get an endoscopy.

Last edited by Ovechkin; 11-21-2011 at 11:15 AM.

 
Old 11-21-2011, 11:16 AM   #7
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Re: Sliding hiatus hernia?

What kind of surgery?

 
Old 11-21-2011, 11:25 AM   #8
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Re: Sliding hiatus hernia?

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Originally Posted by FM927 View Post
What kind of surgery?
Nissen Fundoplication

 
Old 11-21-2011, 12:58 PM   #9
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Re: Sliding hiatus hernia?

Hello Jane,
How do you measure the severity of heartburn/acid reflux? Does all heartburn have to be treated with something?

 
Old 11-21-2011, 02:25 PM   #10
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Re: Sliding hiatus hernia?

I just got back from the doctor.

He didn't do anything. It was the worst co-pay I ever spent. Again, he doesn't think I have acid reflux because I don't have heartburn.

Honestly, he didn't even have a look at my throat. He just checked my blood pressure, felt my stomach, and told me to make an appointment with my allergist again to talk about auto-immune stuff, but I don't understand why he would say that before even giving me tests.

I don't believe this. What is there possibly left to do besides an endoscopy, or a barium swallow? Or just an X-Ray to see if I have an infection or not?

This is ridiculous. I saw an allergist, I have no known allergies. I got my blood tested, everything came back normal; I don't have coeliac's disease.

Now what? What is there left to do?

As far as I am concerned, I either have two things; acid reflux (LPR) or an infection that won't go away. I took antibiotics. Maybe it rebounded? But I'll never know unless I get it diagnosed somehow.

I have a few questions:

1. What is better at finding a hernia & acid reflux; a barium swallow or an endoscopy?
(i read that only 1/3 of patients find acid reflux with a barium swallow)

2. With the barium swallow procedure, would the X-Ray find an infection in me? i figure that it would either be in my sinuses or in my lungs.

Last edited by Ovechkin; 11-21-2011 at 02:26 PM.

 
Old 11-21-2011, 04:03 PM   #11
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Re: Sliding hiatus hernia?

Ovechkin:

I think you should make an appointment with an ENT. At the present time, your only symptom is sore throat. It COULD be from reflux, but it could also be from the postnasal drip, and the postnasal drip could be caused just by irritable sinuses. Or, you might have an infection of some kind, which the ENT could probably find.

IF the ENT thinks reflux is the cause, you'll have better luck getting a GI to listen to you with the referral in hand.

What treatment do you want, anyway? There's lifestyle changes, PPI's and surgery, and no ethical surgeon is going to do a Nissen without a bunch of tests and a good long trial with PPIs first.

As for what finds acid reflux, sometimes both tests miss it. The endoscopy will usually but not always find HH, and it's very reliable at finding esophageal erosions. But not everyone with reflux will get erosions. I don't have any, and I've had reflux for years.

The barium swallow will identify reflux only if the actual barium liquid is refluxed. Sometimes it spots an HH, sometimes it doesn't.

canon007 and Ovechkin:

The most accurate test to diagnose reflux is pH monitoring. A device to measure pH is placed in your esophagus for 24 to 48 hours and readings are recorded. This is a fairly expensive and uncomfortable test. As I understand it, pH monitoring is usually done only when a patient's symptoms are severe enough to consider surgery.

canon007:

Most people have some heartburn type symptoms at some point. If it's an occasional thing, don't stress over it, just take an antacid. If your symptoms happen frequently, are very bothersome, and simple measures like eating smaller meals or avoiding certain foods don't resolve them, you might require prescription medicines or other treatment.

 
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Old 11-21-2011, 04:41 PM   #12
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Re: Sliding hiatus hernia?

Quote:
Originally Posted by janewhite1 View Post
Ovechkin:

I think you should make an appointment with an ENT. At the present time, your only symptom is sore throat. It COULD be from reflux, but it could also be from the postnasal drip, and the postnasal drip could be caused just by irritable sinuses. Or, you might have an infection of some kind, which the ENT could probably find.

IF the ENT thinks reflux is the cause, you'll have better luck getting a GI to listen to you with the referral in hand.

What treatment do you want, anyway? There's lifestyle changes, PPI's and surgery, and no ethical surgeon is going to do a Nissen without a bunch of tests and a good long trial with PPIs first.

As for what finds acid reflux, sometimes both tests miss it. The endoscopy will usually but not always find HH, and it's very reliable at finding esophageal erosions. But not everyone with reflux will get erosions. I don't have any, and I've had reflux for years.

The barium swallow will identify reflux only if the actual barium liquid is refluxed. Sometimes it spots an HH, sometimes it doesn't.

canon007 and Ovechkin:

The most accurate test to diagnose reflux is pH monitoring. A device to measure pH is placed in your esophagus for 24 to 48 hours and readings are recorded. This is a fairly expensive and uncomfortable test. As I understand it, pH monitoring is usually done only when a patient's symptoms are severe enough to consider surgery.
janewhite1,

The reason why my throat is sore is because I have been clearing it chronically for several months.

I really don't know how I can change my lifestyle any more. I can make sure I am thoroughly chewing my food, eating small, frequent meals, not eat 3 hours before bed, sleep on my left side and elevate my head. I can also exercise more and negate the minor anxiety I have.

Besides that, I don't know what else to do. I never drink carbonated drinks, I don't eat chocolate, or spicey foods. I don't consume any lactose or anything refined. I stopped eating nuts (I read that nuts weaken [or relax?] the LES). I am very conscious of my diet.

What treatment I want depends on what the cause of my symptoms are. I would like to get an endoscopy or a barium swallow, but unfortunately my doctor doesn't even think I have reflux. As soon as I told him I didn't have heartburn, he nearly dismissed the idea. Then, at a follow-up appointment, I asked him particularly about LPR (silent reflux) and his literal response was "What's that?".

He thinks I have Sinusitis (he may be correct), so he told me to return to my allergist for autoimmune. But that doesn't make sense. Sinusitis is caused by 3 things:
-allergies
-infection
-autoimmune

I ruled out allergies. But I never ruled out infection. Now we're jumping to autoimmune? I just don't get it.

In my opinion, it doesn't make sense for me to go through all of that before even getting one lousy X-Ray to confirm if I have even a sinus infection. As I said earlier, I did take antibiotics, but the infection possibly could have rebounded.


My plan is to request an endoscopy and hope for my sake that they find a hernia, H. Pylori or something -- anything.

If I have a hernia, then I would like to get it corrected via surgery. If my symptoms are due to a hernia, then it would be nonsense to even take proton-pump inhibitors, correct? It is my understanding that the quantity of acid isn't the issue -- the issue is that the acid is emerging past the LES.

Proton-pump inhibitors are just going to hurt me in the long run. I have read too many stories about people who took several PPIs and now have to wean themselves off of them and it is causing even worse problems to begin with.

It sounds like an endoscopy is my best bet from here on. But I think I should also be diagnosed for a sinus infection as well.


EDIT: Can't reflux make it more likely for me to have a sinus infection? maybe I have both.

Last edited by Ovechkin; 11-21-2011 at 04:47 PM.

 
Old 12-07-2011, 07:37 AM   #13
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Re: Sliding hiatus hernia?

Yes you can have silent reflux and all this clearing your throat may very well be reflux. What happens is the acid only comes so far up the oesophagus.Yor doctor sounds rubbish to me get a second oppinion. The endoscope will show far more than the barium swallow. I had a barium first which didnt even show I had a hernia. The scope then showed gastric erosions ulcers2 gastritis barretts and a sliding hiatus hernia so really it was a complete waste of time going for the barium meal good luck

 
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