Hiatus Hernia and acid reflux

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Last September I visited a chiropractor and rather foolishly had something to eat before hand. I had mega acid coming up into my throat and felt terrible afterwards.  Very high anxiety kicked in and back in November I had an endoscopy and was diagnosed with a small Hiatus Hernia.  I have suffered very badly with reflux for over 6 months and it's affecting my throat.  Last week I saw an ENT consultant who looked at my throat and said it was inflamed which fits in with the hernia and reflux. I'm taking Lansorozole and Gaviscon but so far I don't feel any better.  I feel very scared and depressed that it will develop into Barrett's and I'll do permanent damage to my throat.  I have been through a period of severe stress for this last 18 months or so.  Is there any hope?  I don't smoke or drink alcohol and am trying a bland sugar free diet.  Does this take time to settle down?  Would be glad of anyone's help or advise.  Thank you.

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  • Posted

    The two issues you need to deal with - acd and reflux.

    Firstly, discover what your trigger foods are by keeping a diary. These are the foods that make you notice the acidity of any reflux and you will need to reduce them. There are various banned foods lists suggested but everyone is different so what affects one may not affect you. A common culprit, however, is fatty food which doesn't break down in acid.

    I'm assuming you're on 30mg lansoprazole (the normal maintenance dose). Taken half an hour before breakfast every day is the best time for these. They become more effective over a few days continuous use. If they are insufficient, discuss with your doctor about doubling them.

    Gaviscon is a useful adjunct to be used if you have a flare up. Unlike lansoprazole, it is immediate acting.

    Drugs, however, may not help the reflux (being meachanical rather than chemical in nature). Lifestyle is the key here.

    Lose weight, if necessary; do not overfill your stomach, eat little and often; avoid tight clothing; avoid exercise after food that will compress your stomach; leave at least 3 hours between your last meal and going to bed; raise the head of the bed by 6 to 8 inches on blocks.

    Once your acid levels are in control, any reflux will be less damaging; once the reflux is under control as well, you should be feeling better.

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    • Posted

      I see you posting all around and helping members understand this better which is very much appreciated. We need more people like you. ;-) I have posted this many times so I guess you have seen some of my posting but I'm still struggling with my symptoms which are different from most people.  I have heaviness on my chest (middle upper chest area) which creates breathing problem specially when anxiety kicks in but I always manage to control my anxiety whcih I'm taking a low dose of medication.  I have Mild Reflux/Sinus and chronic mild gastritis with moderate inflammation. My ENT did a Lorayngoscopy a few weeks back and found mild acid on the back of my throat.  I have taken Omeprazole, Raniditine and now Pantoprazole with negative results. I eat good, don't eat spicy food at all, don't eat big meals ( I have lost 50 pounds in the process) and basically have done everything you mention on your recommendations and I still have the problem.  Besides the chest and breathing problem I can feel a little tingling on my throat which appear to be the acid. I don't cough much, no flare ups, no heartburn and no nauseous at all.   One last note, when I eat is when I have really hard time breathing just with the first bite and even with water. Got myself another GI lookimg for answers and she order me a Barium Swallow (Esophadram) which I'm taking this Friday.   Will like to hear your opinion on this is you have the time. ;-)  btw, when I lay back is when I feel the best so I actually sleep without any symptoms at all.
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    • Posted

      Though the symptoms you describe suggest aspirated extra-oesophageal reflux, if lying down actually reduces the symptoms, it may not be reflux at all but something else. (eg respiratory in origin).

      Hopefully the doctors will help get to the root of your problems following your barium oesophagram.

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    • Posted

      Thanks for your quick reply!  That's exactly my take on this, but my Cardio, Pulmo and Asthma Doctors cleared me on this. They even gave me medication for Astha and COPD (30 days) which did nothing for me. ;-)  Hopefully the test on Friday will lead me in the right direction.  ;-)
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    • Posted

      Some of my symptoms papote53 sound similar to yours. I feel my throat irritated and don't seem to cough much.  Also I feel better at night but my consultant said that the acid could still be coming up silently. Hope that you get some answers and help when you go for your test on Friday.  Please please keep us posted. 
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    • Posted

      Actually I can lay down and 80/90% of the heavines on the chest is gone.   I was just reading about What is extra-esophageal reflux disease?

      EERD is like gastroesophageal reflux disease but the symptoms appear outside the stomach and esophagus.  Patients with EERD often do not have spitting up, heartburn or other signs of reflux disease so the diagnosis can be difficult to make.  Symptoms of EERD include cough, exacerbation of asthma, difficulty swallowing, sensation of a lump in the throat, hoarseness and even chronic nasal congestion.

      From the symptoms above I have hoarseness ( which ENT said is mild acid) and even if I can't breath when I eat I have very mild congestion.  I would say it feels like I have exacerbation of asthma but my Pulmo and Asthma Doctors said I don't have. Now, the test from my Pulmo was 18 months ago which I did not have the same symptoms. I did have my Asthma Doc check like 6 months ago and he said I don't have asthma or COPD.   One thing I do know for a fact, reflux medication has done nohting for me and my GI said that just over the counter medication as needed should help me with my mild reflux and gastritis.  I will post an update once I get the results next week.   For me I have learned to deal with it and do your best to live the best you can.  But if you do not know what you have this is not possible. ;-(  I have seen lately that Doctors always come to the same conclution; ANXIETY!

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  • Posted

    Hello Margot,

    Very sorry to hear of your troubles, which, with three years of similar through gastritis and a nightmare of stress last year, I fully empathise with.

    Firstly, stress is one of the worst things for causing or worsening these kinds of illnesses, so every thing you can do to lessen or eradicate that the better.

    Secondly, what, how and when you eat and drink can also have a major bearing on stomach troubles and reflux, and I have found certain measures that help me to at least be better than I was, if not cured.

    Hopefully you might find some help from my own case and those of others who are in difficulty like you. Best wishes.

    Several small/medium meals per day (I have seven medium, one every two hours or so), rather than fewer bigger ones, so you don't overfill your stomach. Eat relaxed, chew well. Be sat upright for and after meals, not bent or reclining, so you don't squash your stomach and press its contents upwards.

    Fried foods, high-fat foods/meats, dairy, high-salt foods, spicy-hot foods, tomatoes, carbonated drinks, caffeine, alcohol and chocolate can all impact on stomach and reflux troubles for some people, so personal experimentation is key. Minty foods relax the lower oesophageal muscle, as do some of the above foods and drinks, which can let acid up easier, so they are bad. I use a fruity toothpaste, and strawberry gaviscon tablets for the now only occasional acid burn.

    Wholewheat bread, cereals, bananas, hardboiled eggs are a few of the foods that suit me, but there are pulses, rice, various beans (not kidney beans apparently) and many other things to try. Chicken is one of the best meats due to its lower fat content, though even that can hit me and is not eaten lately.

    Stress, excercise and bending activity that pressure and squeeze the stomach are also to be avoided. Be as calm and stress-free as you can.

    Having your last meal a few hours before bed can prevent or lessen reflux at night, but I found that waiting to be too empty caused hunger discomfort, assorted spasms and kept me awake. Because of this I lie down about an hour and a half to two hours after last meal, and this is much better. I lie raised a bit on three pillows, on my right side, which is best for me, though the left side is usually recommended. Other people raise the bed-head itself about 6 to 8 inches or use a wedge affair..

    Another thing that helps me greatly is to not burp after ten minutes after eating, as this can bring acid up and cause heartburn. I get the swallowed air out gently just after the meal, sittiing a little forward, then don't burp till after the next meal.

    Water triggering heartburn is common. It can happen even with non-ill people. I learned that the best way to get my daily requirement is to drink around 130 ml or so with each meal, which, in my case, is added to by some sips of a nutrition drink. So generally I don't have to drink between meals, a thing which would slow my digestion a bit anyway and interfere with my set meal times.

    In tests there was an indication that some people with reflux suffer heartburn through drinking water in several gulps because their lower eosophageal muscle doesn't open and close correctly when doing this with fluid, and so acid can escape upwards. But just adding water to your stomach between meals, when there is still food and fluids in there, will increase its volume and raise it nearer to the top where the muscle is, the pressure of which, if too much water is drunk, can then cause the muscle to open and let stomach fluid up. Cold water can also cause spasms, so sips of usual water is best.

    Some say to drink water only between meals at points when the stomach is empty, but that cannot always be done easily - certainly not in my case, where I need to eat every couple of hours or will lose more weight. I can't have between-meal water slowing things down. So I find that a little drink of water with each bite of food that gets well chewed, then a few more af the end of the meal does the trick. I also have water with two cereal meals, which may sound utterly bland but is fine to me, as I avoid dairy milk and have yet to try my cereals with the likes of oat, rice, almond or soya milk. But they are good milk substitutes for people who don't/can't have dairy, unless a person has issues with them.

     

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  • Posted

    Thank you so much everyone for your replies! I am reading them and carefully digesting (excuse the pun!) your contents.  I will try to work out what the food triggers are by keeping a diary Barretts.  I am on 30mg of Lansoprazole which I have been told to take twice a day. Along with the Gavescon after meals and at bedtime.  The consultant told me it takes 6 weeks to heal a throat inflamed by acid and that's assuming you don't have any more coming up and the time starts again!!  Hey ho!  I guess I have to try and give it chance to settle down and heal. I will keep you all posted with any progress.  I'm so sorry that you are all suffering with this and wish healing for you all. It does help to know that you are not alone out there.  Many thanks.
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  • Posted

    Gosh, I am totally overwhelmed with what I am reading here!  The bit about water, it makes complete sense.  I am trying so hard to loswe some weight after my fight with Lyme and have joined Slimming World.  They advocate drinking loads of water to "fill up on" and I wonder if this is where I am going wrong?  Feel like I am on fire from the back of my nose to my middle, choking in the night and all sorts.  I am so glad I've logged onto here.  I am going to read it again and try and take all the good info in. 
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    • Posted

      I hope that will indeed be part or the whole of your solution. Even someone I know who does not suffer from stomach trouble cannot drink water without heartburn ensuing. Have a read of tips and the experiences of other sufferers as well, seeing as we are all unique and what works for one person might not for another.
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    • Posted

      I certainly will Paul.  It's getting me down to be honest and I was only just starting to feel well after Lyme disease too.  I will re-read the tips and make some notes too.  I am very jumpy about acid and what it can do if left untreated as I lost my Dad to something in that area which I dread with every part of my being.  Not good to dwell on things, need to try and take some positive steps and get to grips with the little blighter!  Thanks again smile
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    • Posted

      You're welcome. The mental side of it can be just as hard on us as the illness, and then any life-stress on top of that completes the nightmare. Good luck.
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  • Posted

    I can feel your stress and I do have sympathy for those who have. I think you better try Nexium for to me it is more effective. Buy the generic it is expensive but it works for me. There was a time that I found it didnt work and it is synthetic brand name is Sandoz made in India. I discovered last night when I talked with one of my workmates I feel sore at my vocal chord. I am worrying that the acid may come to my vocal cord and damage it. I rarely talk to my workmates and last night I talk too much for we have special topic. It can be the case and sometimes I find I have hoarse voice when I talk. I will go to see doctor later on to see what he says. I just worry that I may have laryx cancer. I have been loosing weigh not intentionly. I hope you get the best results from this website that helped me a lot in thinking what is right to do for my reflux. 
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    • Posted

      Hello Thi, a hoarse voice and throat irritation are very common with these troubles. Mine's been a bit poorer today through some acid burn in the early morning. But, yes, do tell your doctor of any symptom that develops.

      As for your weight, it can be difficult to maintain weight when you have to be careful and restricted with what you eat due to stomach troubles. I lost mine very quickly when the gastritis began in 2012, and I'm still trying to get enough back on, even with my seven medium meals a day. So hopefully your weight loss is due to the same thing, but, again, the doc will check it out for you.

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    • Posted

      Thanks Paul, I will post the doc's advice. You are suffering so long I just wonder have you thought of surgery? I am thinking of it for I dont like medication. I also have asthma and sinusistis which i think caused by my reflux. Another thing Paul, though I have Zantac and all the medication, it doesnt recover as normal, so I think better is surgery but decision is doc's. I hope you find a best solution sometime confuse and scare delay our wise decison and we may lost opportunity to get well earlier and less sufferring.  
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    • Posted

      I took Nexium for 10 days, just 20mg once daily and it worked better than the Pantoprazole 40 I'm taking today.  Maybe I will try again Nexium - My on

      ly concern is that Nexium is basically Omeprazole and omeprazole had a moderate interaction with another medication I'm taking. Sure, Doctors will allow you to take it unless is High the interaction.  I also have houseness and mild acid on the back of my throat and vocals.  No concern for my ENT, she just said to take my medications and the same old story about eating certain foods which I have been doing for some time now. Lost 50 pounds and I hate it. ;-( I was feeling better, stronger and healthy when I was eating normal and taking no medication at all. Then after I started with medication for HBP, sinus and Cholesterol is when this all started with my chest and breathing problems and now with reflux and gastritis as well. Yes, I no longer need medication for HBP or Cholesterol which is the good side of this diet.

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    • Posted

      I'm quite certain my degree of trouble wouldn't be judged as worthy of surgery compared to some other people's, and I am better than in the first year, though still progressing and prone to poor days and bad ones through trying certain foods out, etc.

      Yes, unfortunately sinusitis and asthma symptoms can arise through these problems. Barretts, who you know, had the surgery you might be speaking of, so if that does become an option for you sometime, he will have some advice about that. Be better if you could improve without surgery, though, so try all the possible ways first.

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    • Posted

      I agree with you in term of surgery is the least choice of solution. I m worrying that with time, it may get worse. Then if I decide to go for it, will I have enough energy to go through when at this stage I can go through it. I suppose with all the food I try to avoid and with old age, case would be more complicated. Well, I find that dam if I do and dam if I don't.sad
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    • Posted

      I am happy for you that you feel better but to normal stage as before reflux happen, I dont know. Some people says the surgery will help but I am scared of surgery and tests. Last time, I went for endoscopy, I feel worse. My hoarse voice not alll the time is my concern. I took Zantac at night and it helps me. I feel weaker because I dont eat much meat and may be because stress. I have Zline irregular that bothers me that one day I cant swallow for it may become tumour. Another concern is the specialist dont take biopsy for it is near my throat. Sometimes, I wonder if life is  worth to live when even the normal food I cant eat and I stay hungry, half full and feeling no energy to work, to keep the acid level in my stomach. 

       

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    • Posted

      There are many different PPIs which research has shown are all as effective as each other when taken at equivalent dose though some patients find they tolerate one more than another.

      Pantoprazole is generally well tolerated but if you have found esomeprazole (nexium) better, you may need it. 20mg esomeprazole is equivalent to 40mg pantoprazole.

      If you visit the www BarrettsWessex org uk website, you'll find a page on Drugs from the drop down under the Treatment tab which also includes links to the research.

      I've appended an image showing table of equivalents and UK costs to NHS. For our US readers, there's also a chart of some of the US costs at the foot of the page.

      Your symptoms sound more of reflux than of acid, which acid suppressants are not so good at tackling. It starts with gastro-oesophageal reflux from the stomach into the oesophagus, continues full column and refluxes into the respiratory system.

      Drugs are good at managing bio-chemical interactions (eg reducing acid) but not so good for bio-mechanical problems such as reflux.

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    • Posted

      Thanks Barret, that is one thing I did not take in consideration while taking these medications, even if I knew how it works. For example Valium and Xanax,   10 mg Valium is = to 0.5 mg Xanax, sure valium is long acting and xanas is short acting.   But for some reason I was always under the impression 40mg Pantoprazole was the same as 40mg Esomeprazole or Omeprazole.  I did take Omeprazole 80mg daily for 30 days and it did nothing for me, just like Raniditine 300mg.  I have never taken any OTC medication, but my Psychiatrist recommended Mylanta.  Now, my ENT did find mild acid on the back of my throat/voice box. But she said it was really mild.  Well. 3 more days for my test, really hope they have an answer for me but I really believe Asthma is part of the equation. ;-(

      Thanks again Barrett! ;-)

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    • Posted

      Hello Thi, do tell the doctor of your eating difficulties, being hungry, etc. I have to eat around every two hours. Maybe you could have ripe bananas or something with you at work and so on, so that you can ease the hunger and get some good energy food in rather than none? I know it is hard to find a good eating routine with these vicious problems, but staying hungry is a horrible thing to have to endure.
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    • Posted

      I'm actually not felling better, Pantoprazole appear not help me much if any.  Barrett has opened my eyes with his response and I have done alot of reading about non-acidreflux.  It's funny that one medication they have tested for this is Baclofen which appear to help with upright reflux and belching. But nothing conclusive so far. but their is hope.  Is just happen that my pulmonlogist gave me Baclofen for chest muscle pain about 6 months ago and I have only used it twice because is only as needed up to twice daily.  It does have a moderate interaction with any medication that may cause dizziness or drowsiness but in my personal case it did not. Actually I was disapointed because is a muscle relaxer and the other muscle relaxer I had in the past helped me sleep better. So my next step is to give this a try because I do have the whole bottle and I am authorized by my Doctor to take it. As for eating, I eat 6 times daily, 3 small meals, 2 shakes and one last mini skake at night (trying to gain some pounds) The last shake is around 8:30PM but is only 2 oz of boost which has 125 calories. I can't eat every 2 hours like Paul, but I try alteast every 2 1/2-3 hours.  I don't wait till I get hungry, is not good for our condition to be hungry and then eat.  I do go to be at 11PM so after I have those 2 oz of boost I wait 2 1/2 hours to go to bed. I do lay down at 10:30PM but not in my bed.
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    • Posted

      btw, I'm also taking something trying to keep those fruits and veggies working for me which is also helping me sleep better.  ;-)
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    • Posted

      Hi there my GI Doctor is having me do a peppermint oil trial instead of the muscle relaxer baclofen.  One to two drops in water. Suppose to relax the muscle too.  Have to admit it appears to be working.  I somehow lost my other pills: antidepressants Max strength omeperzole Can't find the two week pill box anywhere and can't refile for another week and a half.  Actually felling better just doing peppermint oil and really watching what I eat. Lost of alkaline 9.0 ph water too.   
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    • Posted

      Hi Paul, thanks for your care. I do appreciated. I just went to doctor today telling him about my problem with hoarse voice when I am talking too much, and the soreness at the back of my throat which never happened before. I wake up today with a hoarse voice and he refers me to ENT he also explains that it may be inflamed but if it doesnt go away then I can go to se ENT. So I wait and see. It is weird that when my stomatch empty, I feel uncomfortable not the hungry feeling. It is not pain, it is not sore but just very funny feeling that I feel the urge to fill it up with water or anything I can. I am thinking of quitting job but the money to go to specialist and medicine very expensive. The professionals know how to rob us well in their professional way. So again, dam if I do and dam if  dont. Cest la vie or that's life, I guess. One thing positive is it seems to me the reflux doesnt get worse. Count it every day is the only solution now. I am preparing well now with soya milk powder to bring to work just. Doctor advise me to eat before 5pm and go to bed at 10pm then I will be fine even if I get too sleep that I may not know the acid comes back to my throat but when he knew I work shift he only said it is hard to digest food. I am thinking of drinking milk only in the evening at work and I hope it will work. Thanks again for your kindness. God bless.
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    • Posted

      Hi Papote,

      Thanks for sharing with me the way how to handle your reflux. I cant eat like Paul for if I eat six meals I will stop drinking water and I think water is good for your acidity too and for kidney. I am thinking of drinking milk at 8:10pm instead of dinner and see how it goes. So the teatime will be my mealtime and mealtime will be tea time. Btw, if you dont sleep in your bed where do you sleep? I am thinking of buying a raising bed like hospital bed but I dont know where it sells. I googled but unable to find one store in Austrlalia. I have also have lots of stress at the moment but I cant avoid it for I dont know what solution is good for me. confused 

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    • Posted

      Hi Thi, yes, shift-work can be a strange thing for the body. I hope your milk experiment works. Trying such things can be worthwhile sometimes. For three years I've done that with diffferent foods, milk alernatives like rice, oat and almond. But I'm still trying this and that.

      If you have been too empty too often through not eating enough, maybe that could make you have the odd feeling you speak of rather than normal hunger. But do try to gradually eat more in time, even small amounts of high-calorie foods. Such a difficult thing to find a good way with each of us being different and often with our own ideas of what might be best.

      I hope you can find a good bed like you mention, and that it makes a difference if you are more upright. I'm off to mine now. Take care.

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    • Posted

      jejejeje, I sleep in my bed after 11PM, just like back before going to bed around 10:30 in my living room so I can get ready to go to bed.  It works for me, when I go to bed I'm ready to sleep.  ;-)  All you need is a Wedge Incliner (pillow). You can get them on the internet. Alomond Milk is the other option for me at night, but it has less calories than regular milk. ;-)
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