hiatal hernia advice.. have endoscopy, 24 hr PH, manometry results.

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drtinsac
Regular Member


Date Joined Apr 2012
Total Posts : 458
   Posted 4/17/2012 10:01 PM (GMT -6)   
Hi everyone- I just found this forum and it looks like there are many very helpful and knowledgeable people here. Hopefully I can help others, and I would like to get your input on what I've been dealing with the past couple years. I will try to keep it short but will probably not succeed.

I am 34 male, 5'10 about 145 lbs, very healthy diet, exercise regularly, no smoking, fairly relaxed guy.

CLIFF Notes: Continuous sour taste when on PPI or H2 blocker, 1cm hiatal hernia, "chronic gastritis", no heartburn, no h. pylori.

The first indication I had a problem was that I was always swallowing, I always had throat tightness and needed to swallow, but that didn't relieve the need to swallow. I lived with it for over a year, thinking maybe it was in my head, and finally went to see a dr. She diagnosed me with GERD which was surprising to me as I have never had heartburn nor had I noticed regurgitation or any other common symptom the dr. asked me about. I was put on Omeprazole 20mg/day and to cut out coffee and alcohol (I had 1 cup of coffee on empty stomach in AM and 1 beer in PM typically).

The first morning after taking Omeprazole and not drinking coffee, I felt much more relaxed feeling in my gut in the morning, it was a huge difference. I noticed after a few days that my throat was not tight anymore (what a relief) but I had a sour taste ALL day -- starting about 10 minutes after my first meal, lasting the rest of the day. I went off Omep., kept with the good diet, but the throat tightness came back. Went to see dr. again who referred me to a gastro. He ordered 24 hour PH study and manometry.

The PH study showed a low DeMeester score (not indicative of GERD), low to normal amounts of refux episodes etc (I checked against healthy subject data.. I work in public health and do lots of journal searches), and my sour taste symptom was associated with "weakly acidic" reflux.

The manometry study was normal and the results did not suggest hiatal hernia (however data shows that manometry is not an accurate test for detecting HH compared to endoscopy). I again compared against healthy subject data, and my numbers were actually very good.

(I thought my symps might be a pylori infection, so my primary doc let me try the sequential eradication therapy for 10 days.. tolerated it fine but do not know if it helped anything).

I went back on Omeprazole just to keep the throat tightness away but continued to have the sour taste all day. I asked the gastro for an endoscopy. That was done on April 6. He noticed a small hiatal hernia (1cm), did not "see" any gastritis but did see changes around the esophageal junction consistent with acid reflux. Biospies were taken. No H Pylori however the analysis of the stomach sample showed "chronic gastritis".

All the gastro doc said was to continue following anti reflux measures and that if the sour taste continued, he could give me an low dose of antidepressant since I was "overly sensitive" to the sour taste (which can be very strong, about 6-7 on a scale of 1-10).

So that's what I know so far. I went back on Omeprazole after the endoscopy, but 20mg twice a day, to get rid of that throat tightness but still have the sour bitter taste all day. I am going to stick with this for 6 or so weeks to see if the sour taste goes away somehow. I have also tried ranitidine but it had the same sour taste effect for me which I concluded is a weakly acidic mixture that still somewhat irritates my throat.

I am puzzled as to what is causing this weakly acidic mixture to come up. Is "chronic gastritis" the cause, or is the small hiatal hernia the cause? I do not have any stomach pain, so I'm not sure if the gastritis is the culprit. If the hiatal hernia is the issue, it would be quite a relief since I have tried everything and the sour taste continues when I am on acid reducing/blocking meds. When I am not on those meds, my throat gets tight, I swallow a lot, but very little to no sour taste (I guess I'm swallowing enough to keep it down).

Anways if anyone has any thoughts, I'd love to hear them. I am thinking I'll try another gastro doc who might be open to surgery if the hernia is the issue here, my current gastro doc doesn't seem to think I have much of a problem and I don't want to just mask the sensation of the acidy taste with an anti-depressant.

Thanks for any thoughts.

Post Edited (drtinsac) : 4/17/2012 9:14:14 PM (GMT-6)


dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7188
   Posted 4/18/2012 11:26 AM (GMT -6)   
Hi drtinsac,
Welcome to Healing Well!  Glad you've joined us.  It sounds as if you're in exactly the right place.  It sounds as if you're doing all the right things--following up with doctors and looking for answers to what's going on.
 
I will say one thing about DeMeester scores. I had terrible asthma that was not controllable with steroids, and my primary care and asthma docs were tearing their hair out as they tried to keep me breathing.
 
I had been under treatment for GERD for probably ten years or so at that time.  Like you, I never had high volume reflux or regurgitation of food.  Still, my asthma and family docs both were certain that my reflux was creating my problem. 
 
I went to my GI doc (my other docs had sent records indicating their concern).  This was my second GI doc...my first one did me absolutely no good.  I'd been hospitalized for gastritis/reflux-induced asthma that was dangerously bad, and he still didn't do any testing or help me in any way.  Actually, he had done an endoscopy earlier, and he said there was no inflammation of the esophagus.  (I was alreay on PPIs)
 
Anyway, I digress. He ordered a barium swallow, a manometry, and a 24hr PH monitor.  The barium swallow indicated a hiatal hernia, the manometry showed normal swallowing, and some weakness in the LES.  My first DeMeester score was 4.  That is obviously low-normal.  So, my GI doc sent me off, telling me that my asthma was not being caused by my reflux.  (I was already on 40mg Protonix twice a day, and 300mg Ranitidine at bedtime.)
 
This was highly frustrating to my family doctor, especially.  After 4 years of sick, sick lungs, and no support from my GI doc, he referred me directly to a surgeon he recommended.  I saw him, and he did another barium swallow and endoscopy.  That surgeon (I'm sure in consideration of the history my family doc sent along) said I'd be a good candidate for a Nissen and that I should schedule one.
 
I'd done a lot of research and I knew that the surgeon I chose would be of utmost importance, so I took that experience and informaton back to my GI Doc.  He did another PH monitor and my score was slightly over 14, which is borderline, but still very near the high side of normal.
 
Finally, though, my GI doc began taking my family doc seriously.  He said, that it was possible that "a few good refluxes in a day" could be enough to cause problems for my lungs.  He advised me that I could continue treating my reflux with medication (which I'd been doing for years without any relief) or he could refer me to the surgeon to discuss the possibility of a Nissen.
 
I guess I'm telling you all this so you can realize that  a low DeMeester score is not necessarily an indication that you don't have a problem.  It's a picture of your reflux during a 24 hour period.  It doesn't mean that you don't have higher peaks on certain days. 
 
My surgery has made a huge difference in my life, as my lungs are now healthy again.
 
It's certainly not something to jump into, and is a last resort.  I wish I'd pushed harder, earlier, for surgery, though.  I'm now dealing with adrenal insuffiency and thin skin that tears and bruises easily because of the high doses of steroids I took while my lungs were bad all those years.
 
Do you have the head of your bed elevated?  Bedtime is when a lot of the damage is done.  You can get bed risers and/or boards or blocks to put under the legs at the head of the bed.  It allows gravity to help keep things in your stomach where they belong.
 
Yes.  In my case, before I had surgery, if I had gastritis my reflux was definitely worse. 
 
 I'm all for getting a second opinion, though...
Good luck figuring it all out!  Again, glad you've joined the forum. 
I'm sure others will be by soon to weigh in and offer support
 
Best wishes,
Denise
Words of wisdom by Eckhart Tolle:
"Whatever you fight, you strengthen, and what you resist, persists.”

“Worry pretends to be necessary but serves no useful purpose”

“Accept - then act. Whatever the present moment contains, accept it as if you had chosen it. Always work with it, not against it.”

drtinsac
Regular Member


Date Joined Apr 2012
Total Posts : 458
   Posted 4/18/2012 12:30 PM (GMT -6)   
Hi Denise, thank you for the reply and the information on DeMeester.

To answer your question, yes I do have the head of my bed elevated approximately 7 inches. I did that as soon as I was first diagnosed with GERD, in addition to other lifestyle measures of cutting out caffeine and alcohol.

Another frustrating part of it is that other than the reflux symptoms, I felt fine and led a very healthy life. I mean literally eating chicken breast, brown rice and veggies for lunch and dinner, exercising at least 30 minutes a day. So when I read the lifestyle recommendations about eating smaller meals, decreasing fatty and spicy foods, avoid excess alcohol etc, losing weight, stopping smoking, none of them really applied.

But anyways, as far as lifestyle, I am and have been doing whatever I can, however these reflux symptoms continue. I am really hoping the hernia is the cause since it's one of the only things that makes any sense to explain it.

Dear
New Member


Date Joined Apr 2013
Total Posts : 1
   Posted 4/24/2013 6:48 PM (GMT -6)   
Hi
I was just diagnosed with 1cm hernia same as you after they performed an endoscopy. I was suffering from acid reflux and I wanted to get check. I usually suffer stomach problems when my stress levels get really high. I got my stomach checked out and They didn't find anything wrong except the hernia. They told me not to worry about it but now I'm kind of worry since I don't want it to get bigger. What did they say to you about your 1cm hernia? Are you worry about since there is no cure?
Stay healthy!
Thank you and hope to hear from you

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 4/24/2013 7:02 PM (GMT -6)   
Dear,

Welcome to Healing Well.

Most people have a hiatal hernia of some size. Most people don't ever know they have it unless they start having GI issues. The size of yours is actually relatively small. The hernia is where the esophagus goes through the diaphragm and normal life activities usually won't enlarge it, but things like car wrecks where the seat belt pushes very hard on the belly can enlarge it.

Have you tried any meds or anything else to help with the reflux? If it's worse at night you can raise the head of your bed a few inches to help keep things down and try not to eat at least 3 hours before going to bed. Don't just add more pillows to your head as that actually puts more pressure on your belly and makes things worse.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

drtinsac
Regular Member


Date Joined Apr 2012
Total Posts : 458
   Posted 4/24/2013 7:07 PM (GMT -6)   
Dear - please locate my other threads. In short, I had fundo which seems to have relieved my throat tightness, however the sour taste and burning tongue persist.
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