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Flare up of hiatal hernia, reflux, abdominal tenderness, back pain, excessive saliva. Pepcid ineffective. What to do?

Jan 2013
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Internal Medicine Specialist
Practicing since : 2003
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Night before last I started having flare up of hiatal hernia, reflux esophagus, tender upper abdominal, and middle back pain. For 1st time, also have excessive saliva periodically, when pain flares up, and gagging reflex. Pepcid hasn't worked this time to stop symptoms. I'm on vacation. What else can I do?
Posted Fri, 12 Apr 2013 in Abdominal Pain
Answered by Dr. Mayank Bhargava 2 hours later
Welcome to XXXXXXX forum.

Let me know the associated symptoms along with mentioned.
Do you have acidic belching/ abdominal discomfort/ excessive flatulence?
Have you undergone endoscopy previously?

With the available described symptoms, there appears to be possibility of peptic ulcer disease.
Presence of tenderness in upper abdominal suggests the diagnosis.
Peptic ulcer disease is a group of disorders comprising of nodular gastritis, follicular gastritis, erosive gastritis, gastric and adenocarcinoma.
Peptic ulcer disease is caused by helicobacter pylori bacteria, bile reflux induced, intake of spicy oily food.

Hiatal Hernia is an anatomical defect involving lower esophageal sphincter caused by its weakness.
Increased acid production by any means with reflux may cause irritation in esophageal mucosa with excessive saliva production at its protective mechanism.

You should consult with XXXXXXX medicine specialist/ gastroenterologist and should go for through check up.
You should go for serum amylase and lipase (as back ache is also present), complete blood count, thyroid profile, blood sugar, endoscopy along with biopsy for better clarification.
You should also go for urea breathe test for H.Pylori bacteria.
If Urea breathe test is found to be positive then you have to take complete eradication therapy for H. Pylori bacteria.

Meanwhile, you should take proton pump inhibitors along with prokinetics for relief of your symptoms.
You should avoid tomatoes, citrus fruits, tea, coffee, chocolates and oily spicy foods.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava

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