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On medication for acid reflux after hiatal hernia repair and having pain in collar bone. How to get relief?

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Internal Medicine Specialist
Practicing since : 2000
Answered : 1417 Questions
Hi Doc

I had a hiatal hernia repair 4 years ago. I was regurgiating food but after the operation that was sorted for However I am now getting alot of us sickness in the morning and a feeling of too much mucus durinthe whole day. I am on ati reflux meds 30 mg twice daily and they are not controlling symptoms. I do not have heart burn and did not have that befre repair either. The barium swallow that I had a month ago showed repair contact and no reflux. The ENT surgeon said that mucus is pooling in my throat the gastro enterolgist says barium swallow shows no acireflux. Thge gastro enteroligist is very unbothered and uncaring. Can you advise what I can do. It is only fortunately the consultant ENT surgeon who is at least trying to nhelp and prescribing the anti relux medication. I find the mucus sickness tiring andaffects my voice occasionally by making it hoarse and I am getting low grade pain in my collar bone area and main problem is retching twice a day every / most days even with anti refux tablets. With thanks
Posted Tue, 4 Dec 2012 in Digestion and Bowels
Answered by Dr. Sudhir 8 hours later

Thanks for the question.

In view of your symptoms and previous history, the possibility of recurrence of reflux with some aspiration of acid content in lungs seems likely. Aspiration in lung leads to excess mucus formation.

Barium swallow may not always pick up reflux as images might not be taken when reflux occurs. Or while performing barium swallow reflux might not have occurred. Even the position in which barium swallow is performed plays a role in diagnosing reflux. And in most patients barium swallow is performed on empty stomach and patient might be getting reflux on full stomach. It's more common to get reflux when stomach is full and lower esophageal sphincter is under pressure.

There are two other investigations which can help in your case: Esophagus PH monitoring and esophageal manometery.

I think you should get a second opinion from a more caring gastroenterologist. Depending on these investigations, your physician can suggest more appropriate treatments.

Hope this answers your question.
Please ask if there are doubts.
Above answer was peer-reviewed by
Follow-up: On medication for acid reflux after hiatal hernia repair and having pain in collar bone. How to get relief? 3 hours later

Thank you for your advice and reply.

I was so pleased when the barium swallow showed hiatal hernia repair was intact when i had that drink about 6 weeks ago but the gastro gastro enterologist just says that shows no acid refux when he knows my hist ory- he was involved in diagnosing the hital hernia which was large 4 years ago. I had three tests then and after the second test he went for the 24 hour ph monitoring. By way of background i had been regurgiting food for about 10 years in morning if i had breakfast early so i saw a consultant ENT surgeon - now retired - who said that large polyps were causing the regurgiation, he removed the polyps and then he said drink fizzy water as i must have something in the morning so i did that and did not ear until say 9 am in order to avoid regurgiating food. Now regurgiation of food has been sorted by the hiatal hernia repair 4 years ago but there is just a tiring mucus sickness of just mucus every day.

Do you i think ask my current and open minded ENT surgeon to refer me to another enterologist? as although he is doing his best to help and noticed the pooling of mucus in my throat which he says is like a half blocked drain. The gastro enterolist just says that the cat scan of my sinus showed polyp and mucousal inflamation and these caused problem now but my consultant ENT surgeon says that the polyp is small and the inflamation is minor and would not cause mucus sickness and he has let the enterologist know trhis. What i do not understand is why the enerolgist has such a closed mind when there is a pooling of mucus in my throat which the ENT consultant continues to think significant and there is my hisory of having a large hiatal hernia then repair in Aproil 2008 - whilst fortunately intact - shows that problem might be developing. With many thanks for your advice all the best XXXXXXX
Answered by Dr. Sudhir 2 hours later

Thanks for detailed reply.

This excess mucus in throat can form either in the region of nose/sinus or lungs. Since ENT surgeon thinks sinus inflammation is minor, it is unlikely to cause of mucus formation. In that case, mucus forming in lungs seems quiet likely.

And in cases of reflux/repaired hiatus hernia one should think of aspiration to lung leading to inflammation and formation of mucus.

Barium swallow is good in diagnosing hiatus hernia and in showing results of operation, but since reflux is momentary event, it can be missed. So I would recommend other tests to be done.

I think you should see another gastroenterologist and request your current ENT doctor to co-ordinate with him/her.

Hope I have answered your queries. Please ask if there are doubts.


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