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Dr Sarah Jarvis

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Diagnosed with a hiatus hernia and oesophagitis - difficulties with swallowings

I have recently been diagnosed with a hiatus hernia and oesophagitis. I’ve been prescribed 40 mg omeprazole daily, which I have been taking for nearly six weeks. I am still having difficulties with swallowing, food gets stuck and I end up vomiting. Any suggestions as I am fed up with not getting to eat a whole meal

- Dianne, UK


It’s not clear whether your diagnosis of hiatus hernia and oesophagitis (inflammation of the gullet) was made on the basis of your symptoms or whether you’ve had an investigation to look at the lining of your stomach. This procedure, called an endoscopy, involves a small flexible camera on a tube which is passed down your throat and your oesophagus into your stomach.

Hiatus hernia and oesophagitis are common, affecting millions of Britons at some point in their lives – up to one in three adults have occasional heartburn. Symptoms include burning pain behind your breastbone, often worse on lying flat; feeling, or sometimes being, sick; an acid taste in the back of your throat; and hoarseness or sore throat. Occasionally heartburn can be mistaken for a heart attack and vice versa.

Cancer of the oesophagus is definitely not common, but it does affect about 13,000 people a year in the UK, most of them over the age of 55. Because it is so serious, it is essential to get any ‘red flags’ which might point to a cancerous cause investigated. These symptoms include food getting stuck as you swallow, or pain or difficulty on swallowing, as well as vomiting blood or black ‘coffee grounds’; black, tar-like stool; being off your food for any length of time or losing weight for no apparent reason.

Since you’ve been having difficulty with swallowing, it’s crucial that you have a diagnosis of oesophageal cancer ruled out with an endoscopy. If you haven’t done so already, you should speak to your GP urgently about getting a referral. If you have had an endoscopy, you should also have had a test for a germ called Helicobacter pylori. This is more commonly a problem in indigestion but if you have this germ, a one-week course of three medications taken together can help reduce symptoms and cut the risk of them recurring.

Omeprazole is a proton pump inhibitor, one of the newest generation of acid-suppressing medicines used to treat heartburn and indigestion. The previous treatments were called H2 antagonists including cimetidine and ranitidine. All these medications are effective for most people with heartburn, but some may work better for some people than for others. Esomeprazole, another proton pump inhibitor, may be more effective than other drugs in the class for heartburn, although there is no evidence that it is more effective in indigestion.

In severe cases of reflux which are not controlled with medication, surgery may be recommended. If your symptoms really aren’t settling, speak to your GP about getting a referral to a specialist gastroenterologist to discuss possible next steps.

Dr. Sarah Jarvis
Healthcare Professional

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