How do I manage severe stomach pain from a hiatus hernia?

Question

Hi doctor,

I have a 10 cm hiatus hernia. I have been under a specialist for 12 months now. I had two endoscopic procedures done, one under GA, but my gullet was not opening and was severely inflamed. On the CT scan, it shows a dark shaded area. The consultant could not get to see a closer picture or to take biopsies from this area in question. My symptoms are serious stomach and back pain, loss of appetite, pale stools, clay-like dark urine with odor, occasional sickness after eating, cold and hot sweats, warm tummy, cold chest, and legs. My amylase is 56, ALT is 101, and bilirubin is 20. I had my gall bladder removed approximately four to five years ago. I had a helicobacter pylori bacteria infection treated with two courses of antibiotics and pain relief. It does not remove the constant pain I am having. I have had two CT scans and the above but need some secondary advice on what my options are. I am taking Amitriptyline Peptin 80 mg, Esomeprazole, and Gaviscon. I am attaching the reports. Kindly give your opinion.

Answer 1

Hi,

Welcome to icliniq.com.

I want some clarification before I would be able to guide you on what further you should do. TB (total bilirubin) is 20. Is it in mmol/liter, or is it mg/dl? It is important. Please upload the liver function test results. I could not find this in your notes nor in the doctor's summary, which you have uploaded (attachments removed to protect the patient's identity). Secondly, your weight seems extremely low. Have you lost weight? Please let me know if you can upload the CT (computed tomography) scan report and two endoscopy reports as well. I would be in a better position to answer your concerns.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

I do not think you have a major problem with gastroscopy (attachments removed to protect the patient's identity). Some difficulty in passing the scope across your lower end of the gullet can be due to reflux. Since it is mentioned that you have a 10 cm hiatus hernia, you may have acid reflux, which is the sole reason causing your food to be obstructed. The pain you complain of can be due to acid reflux, causing ulcer formation in the lower end of the gullet.

I suggest you take Omeprazole (proton pump inhibitor) 40 mg twice daily for two weeks and see if it improves your symptoms. Please share your biopsy reports once they are available. The doctor mentioned in the report that images of different parts were taken, but I did not see any images. Otherwise would be very helpful to confirm the findings on gastroscopy.

Secondly, I want to tell you that such large hiatus hernias are not amenable to medical treatment such as Omeprazole, and usually end up having surgery of the stomach, which is called fundoplication. But before that surgery, you need to undergo another test called 24 24-hour ambulatory pH meter (potential of hydrogen).

I hope this was helpful. Please get back if you have further doubts.