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From: Mr. Potato Head on 25 Aug 2006 21:37
I had a barium breakfast three days ago and finally got my results. The
doctor says I have a slight hiatal hernia. That's what it is, that's
what's been causing all this discomfort. She told me stay on 20mg of
Aciphex for the next few weeks and see how it goes.

Now, I told her that a lot of this started after I started taking
Synthroid. But the other thing that I was doing was building a patio
right about the same time that I started taking Synthroid. I lifted
about a ton of pavers over the course of two weeks and tore up my back.
Could I also have caused this hernia? does it work the same way as an
inguinal henia?

And how does a PPI help to correct the hernia? that's the part I don't
understand. How does suppressing the acid help? Are we just
concentrating on the esophagus? And how does a hiatal hernia cause a
globus sensation?

Thanks all.

- Alex

From: Howard McCollister on 26 Aug 2006 05:17

"Mr. Potato Head" <alex.cordero(a)gmail.com> wrote in message
news:1156556244.419021.189320(a)i3g2000cwc.googlegroups.com...
>I had a barium breakfast three days ago and finally got my results. The
> doctor says I have a slight hiatal hernia. That's what it is, that's
> what's been causing all this discomfort. She told me stay on 20mg of
> Aciphex for the next few weeks and see how it goes.
>
> Now, I told her that a lot of this started after I started taking
> Synthroid. But the other thing that I was doing was building a patio
> right about the same time that I started taking Synthroid. I lifted
> about a ton of pavers over the course of two weeks and tore up my back.
> Could I also have caused this hernia? does it work the same way as an
> inguinal henia?
>
> And how does a PPI help to correct the hernia? that's the part I don't
> understand. How does suppressing the acid help? Are we just
> concentrating on the esophagus? And how does a hiatal hernia cause a
> globus sensation?
>

Many people have a hiatus hernia and NO reflux, many people have no hiatus
hernia and SEVERE reflux. IF you do indeed have a hiatus hernia, I would
consider that fact pretty much irrelevant. In the absence of direct
visualization of stricture, acute erosive esophagitis, or Barrett's
esophagus, we still don't know whether or not you have GERD, nor if so, how
severe it is.

The hiatus hernia is not your problem, and if your questions above are
indicative of your doctor's explanation of your problem, then she is a
great disappointment. REFLUX is your problem. Malfunction of the Lower
esophageal sphincter. That may or may not have anything to do with your
problem.

Upper GI contrast xrays like your "barium breakfast" are basically a
pointless test in the workup of GERD, and IMHO, any doctor that would order
one especially without other supporting tests like EGD and ambulatory pH
testing, is either under severe HMO-type spending constraints to do a cheapo
workup, or is ignorant of the diagnosis of GERD. All she has done is
discovered an anatomic curiosity that is present to some degree in about 60%
of the population over 50 years old, and which may or may not be related to
your symptoms.

HMc



From: Mr. Potato Head on 26 Aug 2006 12:33
> Many people have a hiatus hernia and NO reflux, many people have no hiatus
> hernia and SEVERE reflux. IF you do indeed have a hiatus hernia, I would
> consider that fact pretty much irrelevant. In the absence of direct
> visualization of stricture, acute erosive esophagitis, or Barrett's
> esophagus, we still don't know whether or not you have GERD, nor if so, how
> severe it is.

Ok, I'm learning a lot more about this daily. No, she has not diagnosed
me as having GERD--not officially. All she's said is that I have
GERD-like symptoms which is what prompted me to ask this group
questions. What are the typical tests that doctors should order to
diagnose GERD?

> The hiatus hernia is not your problem, and if your questions above are
> indicative of your doctor's explanation of your problem, then she is a
> great disappointment.

to be exact, she said that the hernia might be "contributing" to these
GERD-like symptoms.

> REFLUX is your problem. Malfunction of the Lower
> esophageal sphincter. That may or may not have anything to do with your
> problem. Upper GI contrast xrays like your "barium breakfast" are basically a
> pointless test in the workup of GERD, and IMHO, any doctor that would order

yes, I've read this before. This is why I wanted to ask this group
these questions. I need to make another appointment with her and
possibly as for a referral to see a specialist.

Thanks Howard.

From: Howard McCollister on 26 Aug 2006 14:10

"Mr. Potato Head" <alex.cordero(a)gmail.com> wrote in message
news:1156610007.120215.170260(a)m79g2000cwm.googlegroups.com...
> Ok, I'm learning a lot more about this daily. No, she has not diagnosed
> me as having GERD--not officially. All she's said is that I have
> GERD-like symptoms which is what prompted me to ask this group
> questions. What are the typical tests that doctors should order to
> diagnose GERD?
>
>> The hiatus hernia is not your problem, and if your questions above are
>> indicative of your doctor's explanation of your problem, then she is a
>> great disappointment.
>
> to be exact, she said that the hernia might be "contributing" to these
> GERD-like symptoms.
>
>> REFLUX is your problem. Malfunction of the Lower
>> esophageal sphincter. That may or may not have anything to do with your
>> problem. Upper GI contrast xrays like your "barium breakfast" are
>> basically a
>> pointless test in the workup of GERD, and IMHO, any doctor that would
>> order
>
> yes, I've read this before. This is why I wanted to ask this group
> these questions. I need to make another appointment with her and
> possibly as for a referral to see a specialist.
>


I am continually dismayed by the number of doctors that try to treat GERD,
but don't really understand it. You should ask your doctor what the point of
the "barium meal" was. It cost a lot of money, you got some
unpleasant-tasting barium, received a (modest) dose of radiation, and what
did we learn? Nothing. It didn't shed ANY light on your symptoms, provided
no information leading to a diagnosis. It didn't tell us whether or not you
have acute esophagitis, nor did it rule out pre-cancerous Barrett's. Those
things require an EGD, at which time a more accurate evaluation for hiatus
hernia is done anyway.

I despair.

HMc



From: Mr. Potato Head on 26 Aug 2006 19:28
Thanks Howard. Ok, I'll ask her what the point of the test was--good
idea. I'm assuming that it was just a first approach in an upper GI
series--we have to start somewhere and I've never had it done. It's
good that we did it to get it out of the way. It may not be GERD. As I
said earlier, I don't think that I'm getting all the symptoms of a
typical GERD case--but then I'm sure that they're all different. I get
a slight sharp pain in my windpipe when I take a really deep breath,
still some mucus and now a left ear flutter--geez, it may just be
allergies...I've read some GERD cases where they complained about
similar symptoms but of course, not all--ugh, this goes on.

Thanks for your valuable advice on this.

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