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Had radiation for hiatal hernia. Diluted the esophagus due to narrrowing of the esophagus. Surgery necessary?

Apr 2013
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Answered by

General Surgeon
Practicing since : 2009
Answered : 3037 Questions
I just had a upper endoscopy yesterday due to difficulty swallowing. Often, food gets caught in my throat and I have to bring it up in order to breath and continue eating. I have a hiatal hernia and have had radiation back in 2009 from hodgkins lymphoma. I understand that the radiatiation can cause a narrrowing of the esophagus, as well. They dialuted the esophagus yesterday and it is better. Have not met with the Endoscopic Dr yet, but they did say that there was erythema and erosions from the stomach and inflammation. I would like to know if further surgery will be recommended and if so, what ?
Posted Wed, 12 Jun 2013 in Digestion and Bowels
Answered by Dr. Ivan R. Rommstein 3 hours later
Hi and welcome to XXXXXXX Thank you for your query.

Fisrt, esophageal narrowing is obviously caused by radiation,but signs of esophageal inflammation(erytema and erosions) are more likely caused by hiatal hernia and acid reflux. Radiation can cause acute inflammatory esophageal reaction, but not after 3-4 years. Of course, reflux is definitely aggravated by this narrowing and this explains your symptoms.

Now, there are few problems in your case. First, you have hearburn, breathing and swallowing difficulties, stomach pain etc. Second, there is rsk of malignant alteration of these esophageal changes(this is rare but should have on mind, and biopsy should be peformed definitely). Third, there is a risk of stomach ulcer which can lead to perforation and bleeding.

Hiatal hernia is more common treated conservatively(by medicines and changing dietary habbits), but in your case I think there is a good reason for surgical managment as you have combination of radiatin and reflux esophagitis and I dont think that esophgeal mucosa will recover on conservative therapy so your symptoms wont subside. Of course, there is no need to hurry, you can wait and see is there improvement on medical therapy and this is your decision. Also your Hodgkin should be under control if you choose surgical managment.
Procedure is called Nissen fundoplasty. this is relatively simple today and cen be performed laparoscopically in most medical centres. Outcome is great and recovery fast. Esophageal stenosis cant be managed ot this way and some more serious surgery should be done to repair this. But i think that endoscopic dilatation is appropriate and enough for you.

WIsh you good health sir. If you have any questions I ll be glad to help.
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